Mieke Bus

116 Chapter 8 Summary Technical improvements in the design of (flexible) ureterorenoscopes over the past years have resulted in improved visualization of upper urinary tract urothelial carcinoma (UTUC). For this reason, the attitude is radically changed towards treatment of patients with low risk UTUC and a healthy contralateral kidney by the acceptance of conservative treatment. Since conservative treatment is only considered safe in patients with low-volume, low-grade and non-invasive UTUC, treatment should be customized for each individual patient, based on tumour characteristics. Unfortunately, one of the main challenges is to obtain a reliable histopathological diagnosis assessing tumour grade and stage. Recent developments in optical diagnostics showed potential to improve the diagnostic work-up of UTUC. The appli- cability of urinary biomarkers and optical diagnostics in UTUC are increasingly debated. To receive insight in the opinion of the urological community involved in this field, a survey was sent to identify the most promising techniques and understand the need of new diag- nostics in Chapter 2 . Primary objectives of the survey were to to provide an overview of current diagnostics in upper urinary tract urothelial carcinoma and to assess the need for additional diagnostic techniques in the current diagnostic work-up for UTUC and knowl- edge of novel techniques. For this reason, an electronic survey was generated and distributed to all participants of the upper urinary tract tumour registration study by the Clinical Research Office of the Endouro- logical Society and to experts in the field. Analysis was performed based on survey results. In total 81 of the 112 invited individuals responded resulting in a response rate of 72.3%. Of all responders, 61.4% consider current available diagnostics insufficient to select patients for conservative treatment of UTUC. Six optical techniques were evaluated. Four techniques aim to improve visualization of UTUC through contrast enhancement (Narrow Band Imaging (NBI), Photodynamic Diagnosis (PDD), IMAGE1 S™, and digital Retrograde Intrarenal Surgery (digital RIRS)). The other two techniques aim to provide real time information on tumour grade and stage (Optical Coherence Tomography (OCT) and Confocal Laser Endomicros- copy (CLE). Of all evaluated diagnostic tools available today, techniques aiming to improve visualization of UTUC through contrast enhancement were best known among urologists, with in particular digital RIRS and NBI. Digital RIRS including NBI are likely to be beneficial according to the responders. Techniques aiming for real time information on tumour grade and stage were considerably less known among the participants. To outline the potential for future applications of optical diagnostics, we systematically reviewed the literature in Chapter 3 on five optical techniques: NBI, PDD, IMAGE1 S™, OCT and CLE. Literature was reviewed according to QUADAS and IDEAL standards. Only four articles were available for quality assessment. These articles demonstrated high level of evi- dence but low level of IDEAL stage.