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Proceedings Paper

Next generation of optical diagnostics for bladder cancer using probe-based confocal laser endomicroscopy
Author(s): Jen-Jane Liu; Timothy C. Chang; Ying Pan; Shelly T. Hsiao; Kathleen E. Mach; Kristin C. Jensen; Joseph C. Liao
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Paper Abstract

Real-time imaging with confocal laser endomicroscopy (CLE) probes that fit in standard endoscopes has emerged as a clinically feasible technology for optical biopsy of bladder cancer. Confocal images of normal, inflammatory, and neoplastic urothelium obtained with intravesical fluorescein can be differentiated by morphologic characteristics. We compiled a confocal atlas of the urinary tract using these diagnostic criteria to be used in a prospective diagnostic accuracy study. Patients scheduled to undergo transurethral resection of bladder tumor underwent white light cystoscopy (WLC), followed by CLE, and histologic confirmation of resected tissue. Areas that appeared normal by WLC were imaged and biopsied as controls. We imaged and prospectively analyzed 135 areas in 57 patients. We show that CLE improves the diagnostic accuracy of WLC for diagnosing benign tissue, low and high grade cancer. Interobserver studies showed a moderate level of agreement by urologists and nonclinical researchers. Despite morphologic differences between inflammation and cancer, real-time differentiation can still be challenging. Identification of bladder cancer-specific contrast agents could provide molecular specificity to CLE. By using fluorescently-labeled antibodies or peptides that bind to proteins expressed in bladder cancer, we have identified putative molecular contrast agents for targeted imaging with CLE. We describe one candidate agent - anti-CD47 - that was instilled into bladder specimens. The tumor and normal urothelium were imaged with CLE, with increased fluorescent signal demonstrated in areas of tumor compared to normal areas. Thus, cancer-specificity can be achieved using molecular contrast agents ex vivo in conjunction with CLE.

Paper Details

Date Published: 9 February 2012
PDF: 7 pages
Proc. SPIE 8207, Photonic Therapeutics and Diagnostics VIII, 820716 (9 February 2012); doi: 10.1117/12.907623
Show Author Affiliations
Jen-Jane Liu, Stanford Univ. School of Medicine (United States)
Timothy C. Chang, Stanford Univ. School of Medicine (United States)
Ying Pan, Stanford Univ. School of Medicine (United States)
Shelly T. Hsiao, Veterans Affairs Palo Alto Health Care System (United States)
Kathleen E. Mach, Stanford Univ. School of Medicine (United States)
Kristin C. Jensen, Stanford Univ. School of Medicine (United States)
Veterans Affairs Palo Alto Health Care System (United States)
Joseph C. Liao, Stanford Univ. School of Medicine (United States)
Veterans Affairs Palo Alto Health Care System (United States)

Published in SPIE Proceedings Vol. 8207:
Photonic Therapeutics and Diagnostics VIII
Anita Mahadevan-Jansen; Andreas Mandelis; Kenton W. Gregory M.D.; Nikiforos Kollias; Hyun Wook Kang; Henry Hirschberg M.D.; Melissa J. Suter; Brian Jet-Fei Wong M.D.; Justus F. Ilgner M.D.; Stephen Lam; Bodo E. Knudsen M.D.; Steen Madsen; E. Duco Jansen; Bernard Choi; Guillermo J. Tearney M.D.; Laura Marcu; Haishan Zeng; Matthew Brenner; Krzysztof Izdebski, Editor(s)

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