Grading urothelial carcinoma with probe-based confocal laser endomicroscopy during flexible cystoscopy

• DOI: 10.1007/s00345-024-05122-x
• Publication Date: 2024-07-27T07:02:41Z
• Authors: Ben-Max de Ruiter; Jan Erik Freund; C. Dilara Savci-H...; Jons W. van Hattum; Theo M. de Reijke; Joyce Baard; Guido M. Kamphuis; D. Martijn de Bruin; Jorg R. Oddens
• Keywords: Histopathology; Grading (engineering)

Abstract Purpose Urothelial bladder cancer (UCB) care requires frequent follow-up cystoscopy and surgery. Confocal laser endomicroscopy (CLE) is a probe-based optical technique that can provide real-time microscopic evaluation with the potential for outpatient grading of UCB. This study aims to investigate diagnostic accuracy interobserver variability UCB CLE during flexible (fCLE). Methods Participants scheduled transurethral resection papillary tumors were prospectively included intra-operative fCLE. Exclusion criteria flat lesions, fluorescein allergy or pregnancy. Two independent observers evaluated fCLE, classifying as low- high-grade urothelial carcinoma (LGUC/HGUC) benign. Interobserver agreement was calculated Cohens kappa (κ) 2 × tables. Histopathology reference test. Results 34 lesions revealed 14 HGUC, LGUC 6 benign tumors. Diagnostic yield fCLE 80–85% κ 0.75. Respectively, sensitivity, specificity, NPV PPV were: 0–20%, 96–100%, unmeasureable-50% 87%, 57–64%, 41–58%, 44–53% 54–69% HGUC 38–57%, 56–68%, 38–57% an 0.61. Conclusion currently insufficient grade