Novel real-time optical imaging modalities for the detection of neoplastic lesions in urology: a systematic review

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Title: Novel real-time optical imaging modalities for the detection of neoplastic lesions in urology: a systematic review
Authors: Brunckhorst, O
Ong, QJ
Elson, D
Mayer, E
Item Type: Journal Article
Abstract: 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.
Issue Date: 12-Nov-2018
Date of Acceptance: 2-Nov-2018
ISSN: 0930-2794
Publisher: Springer Verlag
Journal / Book Title: Surgical Endoscopy
Copyright Statement: © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor/Funder: Imperial College Healthcare NHS Trust
Cancer Research UK
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: UR150
Keywords: Diagnostic imaging
Optical imaging
Urological malignancy
1103 Clinical Sciences
Publication Status: Published online
Online Publication Date: 2018-11-12
Appears in Collections:Division of Surgery
Faculty of Medicine

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