New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma

  • Maria Teresa Vieira Universidade do Porto - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Vítor Cavadas Universidade do Porto - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal; Serviço de Urologia, Centro Hospitalar do Porto - Hospital de Santo António, Porto, Portugal
Keywords: Image Enhancement, Urinary Tract/diagnostic imaging, Urologic Neoplasms/diagnostic imaging

Abstract

Upper tract urothelial carcinoma (UTUC) is uncommon, but most cases are invasive at diagnosis. Standard of care in patients with UTUC is radical nephroureterectomy (RNU), but low risk UTUC can be treated with kidney sparing surgery (KSS) without compromising oncological outcomes. Current diagnostic techniques have many limitations on UTUC diagnosis, mainly in the detection of carcinoma in situ (CIS), a flat, high grade lesion with high progression risk. Therefore, investigating new diagnostic techniques which allow earlier detection of UTUC lesions has become a relevant matter.

This review provides an overview of the new imaging diagnostic techniques currently available for UTUC diagnosis. A PubMed literature search was performed and articles on narrow band imaging (NBI), Image1 S, photodynamic diagnosis (PDD), confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) were reviewed.

Six articles were selected for review, all of them referring to in vivo human studies. There were no articles on Image1 S. All techniques are compatible with existing flexible ureterorenoscopes. NBI, Image1 S and PDD aim at improving UTUC detection. CLE and OCT aim at providing minimally invasive and real-time histopathological diagnostic. Either NBI or PDD show a better lesion detection rate in comparison with conventional flexible ureterorenoscopy (FURS), but only PDD has shown a better CIS detection. CLE can differentiate healthy from malignant urothelium and high grade lesions from low grade ones. However, it does not allow staging. OCT shows higher UTUC staging and grading sensitivity than biopsy, but lesions greater than 2 mm can cause false-positives.

Combining FURS with new diagnostic techniques could improve its diagnostic precision and capability to properly select KSS candidates. Further research needs to be conducted to validate these new diagnostic techniques on the UTUC diagnosis.

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Published
2019-01-19