Optical diagnostics in upper urinary tract carcinoma

Over the past decade, the attitude towards treatment of patients with low risk upper urinary tract urothelial carcinoma (UTUC) is radically changed by the acceptance of conservative treatment. Since conservative treatment is only considered safe in patients with low-volume, low-grade and non-invasive UTUC, treatment should be customized for each individual patient, based on tumour characteristics. Unfortunately, one of the main challenges is to obtain a reliable histopathological diagnosis assessing tumour grade and stage. Recent developments in optical diagnostics showed potential to improve the diagnostic work-up of UTUC. In this thesis, insight in the opinion of the urological community on the application of optical diagnostics in the upper urinary tract was received. To outline the potential for future applications of optical diagnostics, the literature was systematically reviewed on five optical techniques: NBI, PDD, IMAGE1 S™, OCT and CLE. Furthermore, the ability of optical coherence tomography (OCT) to visualize, grade and stage lesions in the upper urinary tract was explored. OCT is the optical equivalent of ultrasonography, using back-scattered light instead of back-reflected sound waves to produce high-resolution, cross-sectional images in which layered tissue anatomy can be distinguished. In 83% OCT staging of lesions was in accordance with histopathology. Sensitivity and specificity analysis for non-invasive and invasive tumours were 100% and 92%, respectively. For OCT grading of low-, and high-grade lesions, ROC-analysis showed sensitivity of 87% and specificity of 90%.
This thesis demonstrates that optical diagnostics have the potential to improve the diagnosis of UTUC.