Mieke Bus

32 Chapter 3 Abstract Introduction Developments in optical diagnostics have potential for less invasive diagnose of upper uri- nary tract urothelial carcinoma (UTUC). This systematic review provides an overview of technology, applications and limitations of recently developed optical diagnostics in the upper urinary tract and outlines their potential for future clinical applications. In addition, current evidence was evaluated. Literature search A PubMed literature search was performed and papers on Narrow Band Imaging (NBI), Photodynamic Diagnosis (PDD), Storz Professional Imaging Enhancement System (SPIES), Optical Coherence Tomography (OCT) and Confocal Laser Endomicroscopy (CLE) regarding UTUC were reviewed for data extraction. Study quality was reviewed according to QUADAS and IDEAL standards. Results Four articles available for quality assessment, demonstrated high level of evidence but low level of IDEAL stage. NBI and SPIES enhance contrast of mucosal surface and vascu- lar structures, improving tumour detection rate. A first in-vivo study showed promising results. PDD uses fluorescence to improve tumour detection rate. However, due to the acute angle of the ureterorenoscopes there is an increased risk of false-positives. OCT pro- duces cross-sectional high-resolution images, providing information on tumour grade and stage. A pilot study showed promising diagnostic accuracy. CLE allows ultra-high resolution microscopy of tissue resulting in images of the cellular structure. CLE cannot be applied in-vivo in the upper urinary tract yet, due to technical limitations. Conclusions NBI, SPIES and PDD aim at improving visualisation of UTUC through contrast enhancement. OCT and CLE aim at providing real-time prediction of histopathological diagnosis. For all techniques, more research has to be conducted before these techniques can be imple- mented in the routine management of UTUC. All techniques might be of value in specific clinical scenarios and allow for integration, e.g. OCT with NBI, and could therefore improve tumour detection and staging and help selecting the optimal treatment for the individ- ual patient.