Department of Urology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Cancer Center Amsterdam, Amsterdam, The Netherlands.
World J Urol. 2024 Jul 27;42(1):450. doi: 10.1007/s00345-024-05122-x.
Urothelial bladder cancer (UCB) care requires frequent follow-up cystoscopy and surgery. Confocal laser endomicroscopy (CLE) is a probe-based optical technique that can provide real-time microscopic evaluation with the potential for outpatient grading of UCB. This study aims to investigate the diagnostic accuracy and interobserver variability for the grading of UCB with CLE during flexible cystoscopy (fCLE).
Participants scheduled for transurethral resection of papillary bladder tumors were prospectively included for intra-operative fCLE. Exclusion criteria were flat lesions, fluorescein allergy or pregnancy. Two independent observers evaluated fCLE, classifying tumors as low- or high-grade urothelial carcinoma (LGUC/HGUC) or benign. Interobserver agreement was calculated with Cohens kappa (κ) and diagnostic accuracy with 2 × 2 tables. Histopathology was the reference test.
Histopathology of 34 lesions revealed 14 HGUC, 14 LGUC and 6 benign tumors. Diagnostic yield for fCLE was 80-85% with a κ of 0.75. Respectively, sensitivity, specificity, NPV and PPV were: for benign tumors 0-20%, 96-100%, unmeasureable-50% and 87%, for LGUC 57-64%, 41-58%, 44-53% and 54-69% and for HGUC 38-57%, 56-68%, 38-57% and 56-68%, with an interobserver agreement of κ 0.61.
fCLE is currently insufficient to grade UCB.
尿路上皮膀胱癌（UCB）的治疗需要频繁进行膀胱镜检查和手术。共聚焦激光内镜检查（CLE）是一种基于探头的光学技术，可提供实时微观评估，并有可能在门诊对 UCB 进行分级。本研究旨在探讨在软性膀胱镜检查（fCLE）期间使用 CLE 对 UCB 分级的诊断准确性和观察者间变异性。
前瞻性纳入计划接受经尿道膀胱肿瘤切除术的患者进行术中 fCLE。排除标准为平坦病变、荧光素过敏或妊娠。两名独立观察者评估 fCLE，将肿瘤分为低级别或高级别尿路上皮癌（LGUC/HGUC）或良性。采用 Cohen's kappa（κ）计算观察者间一致性，采用 2×2 表计算诊断准确性。组织病理学为参考测试。
34 个病变的组织病理学显示 14 个 HGUC、14 个 LGUC 和 6 个良性肿瘤。fCLE 的诊断率为 80-85%，κ 值为 0.75。分别为，良性肿瘤的灵敏度、特异性、NPV 和 PPV 为 0-20%、96-100%、无法测量-50%和 87%，LGUC 为 57-64%、41-58%、44-53%和 54-69%，HGUC 为 38-57%、56-68%、38-57%和 56-68%，观察者间一致性的 κ 值为 0.61。
fCLE 目前不足以对 UCB 进行分级。
