Mieke Bus

106 Chapter 7 detection and histological diagnosis of UTUC will diminish the total amount of proce- dures and total costs, but studies about the costs in UTUC management should confirm this hypothesis. From a clinical point of view, the ideal adjunct modality for endoscopic procedures in the upper urinary tract should: 1) increase the sensitivity and specificity of detecting malignant and premalignant lesions, 2) provide real-time reliable information on grade and stage, 3) reliably identify the lateral and deep margins in order to achieve complete resection and consequently identify residual tumour within resection margins, 4) easily integrate in modern ureterorenoscopes, 5) be easy to apply with a short learning curve for image inter- pretation, 6) not require the use of toxic or inconvenient chemicals or pharmaceuticals, 7) allow simultaneous display of a conventional white light image such that endoscopic surgery could be guided by such modality in real time, 8) be compact and easy to handle in the operation room and 9) preferably be low in additional costs. (9, 10) Although the combination of endoscopy and the novel optical diagnostic techniques show potential to improve diagnosis of UTUC, none of the described techniques in this overview meets all these conditions. In the future, a combination of optical diagnostics and improved ureterorenoscopy techniques should meet these conditions and provide an optimal grading and staging of UTUC. Future Perspectives on Optical Coherence Tomography in the Upper Urinary Tract The combination of a high resolution imaging technique and modern endo-urological approaches seems promising to improve the diagnosis and therapy of upper urinary tract tumours. (11) Several features of OCT make it well suited for intraluminal diagnostics. OCT can be constructed with common optical fiber components and integrated within conventional endoscopes. Additionally, the OCT system is compact and portable. All of these features make OCT an ideal tool for these purposes in the upper urinary tract. However, the OCT imaging probe currently used in the upper urinary tract is designed for intravascular imag- ing and is not optimally suitable for use in the upper urinary tract. The intravascular OCT imaging probe has a distal tip, containing radiopaque markers and a guidewire exit port for optimal intravascular placement. This long distal tip makes OCT imaging of lesions in calyces difficult. An OCT imaging probe especially designed for the upper urinary tract is for this reason highly desirable. During the finalization of this thesis, we continued to study the diagnostic properties of OCT in UTUC. The primary aim of this subsequent study was to assess the diagnostic accuracy of OCT in determining grade and stage of UTUC in a larger study cohort. Second, we aimed to evaluate the sensitivity and specificity of OCT and biopsy in the diagnosis of UTUC.