Chapter 5 A new generation of optical diagnostics for bladder cancer : technology , diagnostic accuracy and future applications

Context: New developments in optical diagnostics have a potential for less invasive and improved detection of bladder cancer. Objective: To provide an overview of the technology and diagnostic yield of recently developed optical diagnostics for bladder cancer and to outline their potential future applications. Evidence acquisition: A PubMed literature search was performed and papers on Raman spectroscopy (RS), Optical Coherence Tomography (OCT), Photodynamic Diagnosis (PDD) and Narrow Band Imaging (NBI) regarding bladder cancer were reviewed. Technology, clinical evidence and future applications of the techniques are discussed. Evidence synthesis: With RS, the molecular components of tissue can be measured objectively in a qualitative and quantitative way. The first studies demonstrating human in vivo applicability are still awaited. OCT produces high resolution, cross-sectional images of tissue, comparable with histopathology, and provides information about depth of tumour growth. The first in vivo studies demonstrated a promising diagnostic accuracy. RS and OCT are not suitable for scanning the entire bladder. PDD is a technique using fluorescence to indicate pathological tissue. Several studies have shown that PDD increases the detection rate of bladder tumours and improves resection resulting in fewer early recurrences. The relatively low specificity of PDD remains a problem. NBI enhances contrast of mucosal surface and microvascular structures. The technique has clear advantages over PDD and the two studies published to date, showed promising preliminary results. PDD and NBI do not provide information on histopathological diagnosis. Conclusions: RS and OCT aim at providing a real-time, minimally invasive, objective prediction of histopathological diagnosis while PDD and NBI aim at improving visualisation of bladder tumours. For RS, OCT and NBI more research has to be conducted before these techniques can be implemented in the management of bladder cancer. All techniques might be of value in specific clinical scenarios. 55 A new generation of optical diagnostics for bladder cancer |

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