Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York 11794-5281, USA.
J Urol. 2012 Mar;187(3):1063-70. doi: 10.1016/j.juro.2011.10.131. Epub 2012 Jan 15.
We compared the efficacy and potential limitations of white light cystoscopy, narrow band imaging, 5-ALA fluorescence cystoscopy and 3-dimensional optical coherence tomography for early diagnosis of bladder carcinoma in situ.
By expressing simian virus 40T antigen in the urothelium carcinoma in situ typically develops in SV40T transgenic mice in about 8 to 20 weeks and then frank high grade papillary urothelial carcinoma starts to emerge. A total of 18 control and 29 SV40T mice were examined during weeks 8 to 22 by white light cystoscopy, fluorescence cystoscopy, narrow band imaging and 3-dimensional optical coherence tomography. Results were validated by histology. Newly improved algorithms for computer aided detection were applied to acquired 3-dimensional optical coherence tomography images to enhance the quantitative diagnosis of carcinoma in situ in near real time.
Of 29 carcinoma in situ samples 27 were detected by 3-dimensional optical coherence tomography, 1 by white light cystoscopy, 26 by narrow band imaging and 13 by fluorescence cystoscopy. Of the 18 histologically confirmed benign cases 17 were detected by 3-dimensional optical coherence tomography, 14 by white light cystoscopy, 5 by narrow band imaging and 18 by fluorescence cystoscopy. The diagnostic sensitivity of white light cystoscopy (3.4%) and fluorescence cystoscopy (44.8%), and the specificity of narrow band imaging (27.8%) were significantly enhanced by 3-dimensional optical coherence tomography to 93.1% and 94.4%, respectively (p <0.01).
Three-dimensional optical coherence tomography with quantitative computer aided detection can significantly enhance the sensitivity of white light cystoscopy and fluorescence cystoscopy, and the specificity of narrow band imaging for early diagnosis of carcinoma in situ. This suggests the potential of narrow band imaging guided 3-dimensional optical coherence tomography for future clinical detection of carcinoma in situ when effective image guidance is desirable.
我们比较了白光膀胱镜检查、窄带成像、5-ALA 荧光膀胱镜检查和三维光学相干断层扫描在早期诊断膀胱癌中的疗效和潜在局限性。
通过在尿路上皮癌原位表达猴病毒 40T 抗原，SV40T 转基因小鼠通常在 8 至 20 周内发展为原位癌，然后出现明显的高级别乳头状尿路上皮癌。在第 8 至 22 周期间，对 18 只对照和 29 只 SV40T 小鼠进行了白光膀胱镜检查、荧光膀胱镜检查、窄带成像和三维光学相干断层扫描检查。结果通过组织学验证。新开发的计算机辅助检测算法应用于获取的三维光学相干断层扫描图像，以实时增强原位癌的定量诊断。
在 29 个原位癌样本中，三维光学相干断层扫描检测到 27 个，白光膀胱镜检查检测到 1 个，窄带成像检测到 26 个，荧光膀胱镜检查检测到 13 个。在 18 例经组织学证实的良性病例中，三维光学相干断层扫描检测到 17 例，白光膀胱镜检查检测到 14 例，窄带成像检测到 5 例，荧光膀胱镜检查检测到 18 例。白光膀胱镜检查（3.4%）和荧光膀胱镜检查（44.8%）的诊断灵敏度，以及窄带成像（27.8%）的特异性，通过三维光学相干断层扫描分别显著提高至 93.1%和 94.4%（p <0.01）。
具有定量计算机辅助检测功能的三维光学相干断层扫描可显著提高白光膀胱镜检查和荧光膀胱镜检查的灵敏度，以及窄带成像对早期诊断原位癌的特异性。这表明在需要有效图像引导的情况下，窄带成像引导的三维光学相干断层扫描具有用于未来临床原位癌检测的潜力。
