Multiphoton microscopy: a potential intraoperative tool for the detection of carcinoma in situ in human bladder.

TitleMultiphoton microscopy: a potential intraoperative tool for the detection of carcinoma in situ in human bladder.
Publication TypeJournal Article
Year of Publication2015
AuthorsJain M, Robinson BD, Shevchuk MM, Aggarwal A, Salamoon B, Dubin JM, Scherr DS, Mukherjee S
JournalArch Pathol Lab Med
Volume139
Issue6
Pagination796-804
Date Published2015 Jun
ISSN1543-2165
KeywordsAdult, Carcinoma in Situ, Carcinoma, Transitional Cell, Cohort Studies, Female, Histocytochemistry, Humans, Male, Microscopy, Fluorescence, Multiphoton, Monitoring, Intraoperative, Reproducibility of Results, Sensitivity and Specificity, Single-Blind Method, Urinary Bladder, Urinary Bladder Neoplasms
Abstract

CONTEXT: Urothelial carcinoma in situ (CIS) is a precursor of invasive bladder cancer, which if left untreated, will likely progress to more aggressive disease. Approximately 50% of CIS lesions are missed on routine cystoscopy owing to their flat architecture. Furthermore, many benign but abnormal-appearing areas may be biopsied owing to lack of cellular resolution of cystoscopes. Multiphoton microscopy (MPM) is an optical imaging technique that generates subcellular-resolution three-dimensional images from unfixed tissue without using exogenous dyes.

OBJECTIVE: To assess the diagnostic potential of MPM in identifying and differentiating benign from malignant flat bladder lesions, especially CIS.

DESIGN: Seventy-eight specimens (benign = 46, CIS = 23, invasive = 9, as diagnosed on histopathology) were obtained from flat bladder mucosa via transurethral resection of bladder, cold cup biopsy, or cystectomy, imaged fresh with a commercial benchtop MPM, and submitted for routine histopathology. Multiphoton microscopy and hematoxylin-eosin diagnoses were compared.

RESULTS: In 77 of 78 specimens (99%), accurate MPM diagnoses (benign/malignant) were given on the basis of their architectural and cytologic features (nuclear to cytoplasmic ratio, pleomorphism, polarity/organization of urothelial layers, etc). The sensitivity and specificity were 97% and 100%, respectively, with positive (malignant) and negative (benign) predictive values of 100% and 98%, respectively. The interobserver agreement, κ, was 0.93.

CONCLUSIONS: Our study demonstrates the capability of MPM to identify and differentiate benign from malignant flat bladder lesions, especially CIS. With the advent of MPM endoscopes, we foresee their potential as a biopsy guidance tool for early detection and treatment of CIS, thus reducing the rate of biopsies with benign diagnoses and their associated complications.

DOI10.5858/arpa.2014-0076-OA
Alternate JournalArch Pathol Lab Med
PubMed ID26030249
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Brian Robinson, M.D.

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