Mieke Bus

2 19 Introduction At present, the applicability of urinary biomarkers and optical diagnostic methods are explored in UTUC. 1,2 Accuracy in predicting grade and stage of the current diagnostic techniques is limited, making optimal patient selection for nephron sparing surgery diffi- cult. 2 However, most of the results on novel techniques for UTUC are still preliminary or with low level of evidence. 2 The rarity of the disease hampers patient inclusion to reach adequate sample sizes to prove diagnostic accuracy, especially in a short time. Optical diagnostics is a collective term for methods based on the interaction of light with tissue. These interactions include scattering, absorption and fluorescence, all of which are characteristic for certain tissue types. Narrow band imaging (NBI), STORZ® professional imag- ing enhancement system (SPIES 1 ), digital endoscopes for retrograde intrarenal surgery (RIRS) and photodynamic imaging (PDD) aim at improved visualization of tumours. NBI is already successfully implemented in the field of gastroenterology to improve tumour detection rate during gastroscopy and colonoscopy. 3,4 PDD has established its position in the diagnosis of tumours in the urinary bladder and NBI has been implemented in both the urinary bladder and upper urinary tract. 5-7 Optical coherence tomography (OCT) and confocal laser endomi- croscopy (CLE), provide real-time high-resolution histology-like images. Favorable results with CLE and OCT have been obtained in the urinary bladder. Although results on both CLE and OCT in the upper urinary tract are preliminary, application of OCT and CLE in the upper urinary tract is technically feasible and first results are positive. 8-11 Finally, a biomarker that supports a reliable diagnosis of UTUC would make most of the current techniques redundant. In UTUC, the best studied biomarker is fluorescence in situ hybridisation (FISH), also used in gastroenterology and bladder cancer. 12,13 In 2000, a FISH probe assay on voided urine specimen was designed for bladder cancer, called UroVysion, which was demonstrated to be a reliable method in the diagnosis of UTUC in cases with clinical suspicion. 14 To gain insight in the current practice pattern and meaning of urologists for additional diag- nostics we sent out a web-based survey. Primary objective of this study was to provide an overview of current diagnostics in upper urinary tract urothelial carcinoma. Secondary objectives of this study were to assess the need for additional diagnostic techniques in the current diagnostic work-up for UTUC and to assess knowledge of novel techniques. 1 Currently known as IMAGE1 S™