Catheter-based intraluminal optical coherence tomography of the normal human upper urinary tract in vivo: proof of concept and comparison with an ex-vivo porcine model
Objective: Single-slice, cross-sectional, intraluminal optical-coherence-tomography (OCT) is a new destruction-free optical imaging method that could be applied clinically to examine the upper urinary tract from within. In-vivo access to the human upper urinary tract (UUT) was attempted. Similar performance statistics as in ex-vivo porcine UUT were expected for delineation of different wall layers by in-vivo OCT of human UUTs.
MATERIALS AND METHODS: Institutional ethics committee approved OCT in a volunteer sample of 15 patients suspected of having UUT pathology (urolithiasis, strictures, urothelial carcinoma (UC)). Commercially available, catheter-mounted 400-μm-OCT-probes (lateral resolution, < 20 µm) were introduced through a rigid cystoscope and urinary catheter or a rigid ureteroscope. Delineations of different UUT wall layers were recorded for quadrants of OCT images. Continuity-corrected-chi-square-statistics were considered to be significant for P < 0.05.
RESULTS: OCT was technically successful in all patients. Among quadrants of OCT images of normal UUT in vivo (n = 532) and ex vivo (n = 248), respectively, two observers in consensus found that any tissue layers delineated in 454 (85%) and 223 (90%, P = 0.089), urothelium-lamina propria in 362 (68%) and 193 (78%, P = 0.006), lamina propria-muscle layer in 445 (84%) and 200 (81%, P = 0.352), different muscle layers in 191 (36%) and 207 (84%, P < 0.001), and different urothelial cell layers in 17 (3%) and 172 (69%, P < 0.001). Histopathology-confirmed non-invasive superficial UC showed intraluminal, papillary urothelial protrusions with undistorted lamina propria in three patients.
CONCLUSIONS: In-vivo OCT is technically feasible in the human UUT and may demonstrate urothelium, lamina propria, and muscle layer, and recognize non-invasive UC.
1. Geavlete P, Jecu M, Geavlete B, Multescu R, Nita G, et al. (2010) Ureteroscopy--an essential modern approach in upper urinary tract diagnosis and treatment. J Med Life 3, 193-199.
2. Geavlete P, Multescu R, Geavlete B (2011) Retrograde flexible ureteroscopy: reshaping the upper urinary tract endourology. Arch Esp Urol 64, 3-13.
3. Traxer O, Geavlete B, de Medina SG, Sibony M, Al-Qahtani SM (2011) Narrow-band imaging digital flexible ureteroscopy in detection of upper urinary tract transitional-cell carcinoma: initial experience. J Endourol 25, 19-23.
4. Bansal H, Swain S, Sharma GK, Mathanya M, Trivedi S, et al. (2011) Polyscope: a new era in flexible ureterorenoscopy. J Endourol 25, 317-321.
5. Nolte-Ernsting C, Staatz G, Tacke J, Günther RW (2003) MR urography today. Abdom Imaging 28, 191–209.
6. van der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CC, Takahashi S, et al. (2008) CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol 18, 4-17.
7. Mueller-Lisse UL, Meissner OA, Babaryka G, Bauer M, Eibel R, et al. (2006) Catheter-based intraluminal optical coherence tomography (OCT) of the ureter: ex-vivo correlation with histology in porcine specimens. Eur Radiol 16: 2259-2264. doi: 10.1007/s00330-006-0191-8. PMID: 16572332
8. Mueller-Lisse UL, Meissner OA, Bauer M, Weber C, Babaryka G, et al. (2009) Catheter-based intraluminal optical coherence tomography versus endoluminal ultrasonography of porcine ureter ex vivo. Urology 73, 1388-1391.
9. Mueller-Lisse UL, Bauer M, Meissner OA, Reiser MF, Stief CG, et al. (2015) Catheter-based intraluminal optical coherence tomography: mcomparison with digital light microscopy of ureter wall morphometry in porcine specimens. Bladder 2: e12. doi: 10.14440/bladder.2015.46
10. Tearney GJ, Brezinski ME, Southern JF, Bouma BE, Boppart SA, et al. (1997) Optical biopsy in human urologic tissue using optical coherence tomography. J Urol 157: 1915-1919. PMID: 9112562
11. Brezinski ME, Tearney GJ, Weissman NJ, Boppart SA, Bouma BE, et al. (1997) Assessing atherosclerotic plaque morphology: comparison of optical coherence tomography and high frequency intravascular ultrasound. Heart 77: 397-403. PMID: 9196405
12. Fujimoto JG, Boppart SA, Tearney GJ, Bouma BE, Pitris C, et al. (1999) High resolution in vivo intra-arterial imaging with optical coherence tomography. Heart 82: 128-133. PMID: 10409522
13. Tearney GJ, Brezinski ME, Southern JF, Bouma BE, Boppart SA, et al. (1997) Optical biopsy in human gastrointestinal tissue using optical coherence tomography. Am J Gastroenterol 92: 1777-1779. PMID: 9382040
14. Meissner OA, Rieber J, Babaryka G, Oswald M, Reim S, et al. (2006) Intravascular optical coherence tomography: comparison with histopathology in atherosclerotic peripheral artery specimens. J Vasc Interv Radiol 17: 343-349. doi: 10.1097/01. RVI.0000195324.52104.00. PMID: 16517781
15. Boppart SA, Bouma BE, Pitris C, Tearney GJ, Southern JF, et al. (1998) Intraoperative assessment of microsurgery with three-dimensional optical coherence tomography. Radiology 208: 81-86. doi: 10.1148/radiology.208.1.9646796. PMID: 9646796
16. Jesser CA, Boppart SA, Pitris C, Stamper DL, Nielsen GP, et al. (1999) High resolution imaging of transitional cell carcinoma with optical coherence tomography: feasibility for the evaluation of bladder pathology. Br J Radiol 72: 1170-1176. doi: 10.1259/bjr.72.864.10703474. PMID: 10703474
17. Zagaynova EV, Streltsova OS, Gladkova ND, Snopova LB, Gelikonov GV, et al. (2002) In vivo optical coherence tomography feasibility for bladder disease. J Urol 167: 1492-1496. PMID: 11832776
18. Pan YT, Xie TQ, Cw, Du , Bastacky S, Meyer S (2003) Zeidel ML (2003) Enhancing early bladder cancer detection with fluorescence-guided endoscopic optical coherence tomography. Opt Lett 28: 2485-2487. PMID: 14690122
19. Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB (2007) Estimating sample size and power: applications and examples. In: Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB: Designing clinical research. Third Edition. Chapter 6. Philadelphia: Lippincott Williams and Wilkins. pp 65-96.
20. Glantz SA (1997) How to analyze rates and proportions. In: Glantz SA. Primer of Biostatistics. Fourth Edition. Chapter 5. New York, St. Louis, San Francisco, Auckland, Bogota, Caracas, Lisbon, London, Madrid, Mexico City, Milan, Montreal, New Delhi, San Juan, Sydney, Tokyo, Toronto: McGraw-Hill Health Professions
Division. pp 108-150.
21. Messing EM (2002) Urothelial tumors, renal pelvis and ureter. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ (Eds): Campbell’s Urology. Eighth Edition. Philadelphia: WB Saunders. pp 2732–2784.
22. Bader MJ, Sroka R, Gratzke C, Seitz M, Weidlich P, et al. (2009) Laser therapy for upper urinary tract transitional cell carcinoma: indications and management. Eur Urol 56, 65-71.
23. Raymundo EM, Lipkin ME, Bañez LB, Mancini JG, Zilberman DE, et al. (2011) Third prize: the role of endoscopic nephron-sparing surgery in the management of upper tract urothelial carcinoma. J Endourol 25, 377-384.
24. Inman BA, Tran VT, Fradet Y, Lacombe L (2009) Carcinoma of the upper urinary tract: predictors of survival and competing causes of mortality. Cancer 115, 2853-2862.
25. Gadzinski AJ, Roberts WW, Faerber GJ, Wolf JS Jr. (2010) Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J Urol 183, 2148-2153.
26. Solsona E, Iborra I, Ricos JV, Monros JL, Dumont R, Almenar S (1996) Extravesical involvement in patients with bladder carcinoma in situ: biological and therapy implications. J Urol 155, 895–900.
27. Solsona E, Iborra I, Ricos JV, Monros L, Rubio J, Almenar S (2002) Clinical panurothelial disease in patients with superficial bladder tumors: therapeutic implications. J Urol 167, 2007–2011.
28. Seifert S, Mueller-Lisse UG, Degenhart C, Jundt K, Mourched F, et al. (2011) CT urography in women with primary or recurrent pelvic tumors. Background and initial experiences. Radiologe 51, 602–609.
29. Wang H, Kang W, Zhu H, MacLennan G, Rollins AM (2011) Three-dimensional imaging of ureter with endoscopic optical coherence tomography. Urology 77, 1254-1258.
30. Desgrandchamps F, Moulinier F, Cochand-Priollet B, Wassef M, Teillac P, et al. (1997) Microscopic study of the pig ureteral urothelium. J Urol 157: 1926-1927. PMID: 9112564
31. Bus MT, Muller BG, de Bruin DM, Faber DJ, Kamphuis GM, et al. (2013) Volumetric in vivo visualization of upper urinary tract tumors using optical coherence tomography: a pilot study. J Urol 190, 2236-2242.