Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
World J Urol. 2019 Oct;37(10):2155-2164. doi: 10.1007/s00345-019-02646-5. Epub 2019 Jan 25.
Confocal laser endomicroscopy (CLE) is a fluorescence-based fiber-optic imaging technique with the potential for intraoperative grading of upper tract urothelial carcinoma (UTUC). This study aims to (1) investigate the prevalence of the previously proposed CLE criteria for bladder cancer in papillary UTUC, (2) estimate the diagnostic value of CLE for UTUC grading and (3) propose a scoring system for a more quantifiable approach of CLE-based grading of UTUC.
Ureteroscopic CLE was performed in patients with UTUC. Following CLE imaging, co-localized biopsies were taken for histopathologic comparison. Postoperatively, two blinded raters assessed the CLE images.
Fifty-three papillary UTUCs (34 low grade and 19 high grade) were imaged with CLE in 36 patients. All the previously described CLE criteria were identifiable in varying proportions. After excluding 10 non-diagnostic recordings (5 low grade and 5 high grade) due to insufficient image quality, the histopathologic grade was correctly identified with CLE in 26 low-grade UTUCs (90%) and in 12 high-grade UTUCs (86%). The most prevalent CLE criteria with the highest diagnostic potential were cellular organization, morphology and cohesiveness of cells. A scoring system was proposed with these criteria, which yielded similar diagnostic accuracies.
Based on the previously proposed criteria, CLE enables accurate grading of papillary UTUC at a non-diagnostic rate of 19%. The most prevalent CLE criteria with the highest diagnostic potential for grading of papillary UTUC are cellular organization, morphology and cohesiveness of cells. The proposed scoring system may simplify the assessment of CLE images for UTUC grading but external validation is required.
共聚焦激光内镜检查（CLE）是一种基于荧光的光纤成像技术，具有在上尿路尿路上皮癌（UTUC）术中分级的潜力。本研究旨在：（1）研究先前提出的用于诊断膀胱肿瘤的 CLE 标准在乳头状 UTUC 中的普遍性；（2）评估 CLE 对 UTUC 分级的诊断价值；（3）提出一种评分系统，以更定量的方式对 UTUC 的 CLE 分级进行评估。
对 UTUC 患者进行输尿管镜 CLE 检查。在 CLE 成像后，对共定位活检进行组织病理学比较。术后，由两名盲法评估员对 CLE 图像进行评估。
在 36 名患者中对 53 例乳头状 UTUC（34 例低级别和 19 例高级别）进行了 CLE 成像。在不同比例中可以识别出所有先前描述的 CLE 标准。排除 10 个由于图像质量不足而无法诊断的记录（5 个低级别和 5 个高级别）后，CLE 正确识别出 26 例低级别 UTUC（90%）和 12 例高级别 UTUC（86%）的组织病理学分级。最常见的 CLE 标准具有最高的诊断潜力，这些标准包括细胞组织、形态和细胞的一致性。提出了一种评分系统，该系统具有相似的诊断准确性。
基于先前提出的标准，CLE 能够准确分级乳头状 UTUC，其诊断率为 19%。对于乳头状 UTUC 分级，最常见的 CLE 标准具有最高的诊断潜力，这些标准包括细胞组织、形态和细胞的一致性。所提出的评分系统可能简化了 CLE 图像对 UTUC 分级的评估，但需要外部验证。
