Freund Jan Erik, Faber Dirk J, Bus Mieke T, van Leeuwen Ton G, de Bruin Daniel M
Department of Urology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Lasers Surg Med. 2019 Jul;51(5):399-406. doi: 10.1002/lsm.23079. Epub 2019 Mar 28.
With catheter based optical coherence tomography (OCT), high resolution images of the upper urinary tract can be obtained, thereby facilitating the detection of upper tract urothelial carcinomas (UTUC). We hypothesized that the attenuation coefficient of the OCT signal (μ ) is related to the histopathologic grade of the tumor.
In this study, we aimed to define the μ cut-off for discriminating high grade and low grade papillary UTUC.
For this post-hoc analysis, data from OCT imaging of papillary UTUC was obtained from patients during ureterorenoscopy. OCT images and raw data were simultaneously analyzed with in-house developed software. The μ determined in papillary UTUCs and corresponding histopathologic grading from either biopsies or radical resection specimens were compared.
Thirty-five papillary UTUC from 35 patients were included. μ analysis was feasible in all cases. The median μ was 3.3 mm (IQR 2.7-3.7 mm ) for low-grade UTUC and 4.9 mm (IQR 4.3-6.1 mm ) for high-grade UTUC (P = 0.004). ROC analysis yielded a μ cut-off value of >4.0 mm (AUC = 0.85, P < 0.001) with a sensitivity of 83% and a specificity of 94% for high-grade papillary UTUC.
This study proposes a μ cut-off of 4.0 mm for quantitative grading of UTUC with ureterorenoscopic OCT imaging. The promising diagnostic accuracy calculations justify further studies to validate the proposed cut-off value. Implementation of the software for the μ analysis in OCT systems may allow for μ assessment at real time during ureterorenoscopy. Lasers Surg. Med. 51:399-406, 2019. © 2019 Wiley Periodicals, Inc.
借助基于导管的光学相干断层扫描（OCT），可以获取上尿路的高分辨率图像，从而有助于检测上尿路尿路上皮癌（UTUC）。我们推测OCT信号的衰减系数（μ）与肿瘤的组织病理学分级有关。
在本研究中，我们旨在确定区分高级别和低级别乳头状UTUC的μ临界值。
对于这项事后分析，在输尿管肾镜检查期间从患者获取乳头状UTUC的OCT成像数据。使用内部开发的软件同时分析OCT图像和原始数据。比较乳头状UTUC中确定的μ与活检或根治性切除标本的相应组织病理学分级。
纳入了35例患者的35个乳头状UTUC。μ分析在所有病例中均可行。低级别UTUC的μ中位数为3.3毫米（四分位间距2.7 - 3.7毫米），高级别UTUC为4.9毫米（四分位间距4.3 - 6.1毫米）（P = 0.004）。ROC分析得出μ临界值>4.0毫米（曲线下面积 = 0.85，P < 0.001），对高级别乳头状UTUC的敏感性为83%，特异性为94%。
本研究提出了一个4.0毫米的μ临界值，用于输尿管肾镜OCT成像对UTUC进行定量分级。有前景的诊断准确性计算结果证明有必要进行进一步研究以验证所提出的临界值。在OCT系统中实施用于μ分析的软件可能允许在输尿管肾镜检查期间实时评估μ。《激光外科与医学》51:399 - 406, 2019。© 2019威利期刊公司
