Background Current optical diagnostic techniques for malignancies are limited in their diagnostic accuracy and lack the
ability to further characterise disease, leading to the rapidly increasing development of novel imaging methods within urology. This systematic review critically appraises the literature for novel imagining modalities, in the detection and staging of
urological cancer and assesses their effectiveness via their utility and accuracy.
Methods A systematic literature search utilising MEDLINE, EMBASE and Cochrane Library Database was conducted from
1970 to September 2018 by two independent reviewers. Studies were included if they assessed real-time imaging modalities not already approved in guidelines, in vivo and in humans. Outcome measures included diagnostic accuracy and utility
parameters, including feasibility and cost.
Results Of 5475 articles identified from screening, a final 46 were included. Imaging modalities for bladder cancer included
optical coherence tomography (OCT), confocal laser endomicroscopy, autofluorescence and spectroscopic techniques. OCT
was the most widely investigated, with 12 studies demonstrating improvements in overall diagnostic accuracy (sensitivity
74.5–100% and specificity 60–98.5%). Upper urinary tract malignancy diagnosis was assessed using photodynamic diagnosis
(PDD), narrow band imaging, optical coherence tomography and confocal laser endomicroscopy. Only PDD demonstrated
consistent improvements in overall diagnostic accuracy in five trials (sensitivity 94–96% and specificity 96.6–100%). Limited
evidence for optical coherence tomography in percutaneous renal biopsy was identified, with anecdotal evidence for any
modality in penile cancer.
Conclusions Evidence supporting the efficacy for identified novel imaging modalities remains limited at present. However,
OCT for bladder cancer and PDD in upper tract malignancy demonstrate the best potential for improvement in overall diagnostic accuracy. OCT may additionally aid intraoperative decision making via real-time staging of disease. Both modalities
require ongoing investigation through larger, well-conducted clinical trials to assess their diagnostic accuracy, use as an
intraoperative staging aid and how to best utilise them within clinical practice.