PDF(Pubmed)
Abstract：
OBJECTIVE: 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 the diagnostic accuracy and interobserver variability for the grading of UCB with CLE during flexible cystoscopy (fCLE).
METHODS: Participants scheduled for transurethral resection of papillary bladder tumors were prospectively included for intra-operative fCLE. Exclusion criteria were flat lesions, fluorescein allergy or pregnancy. Two independent observers evaluated fCLE, classifying tumors as low- or high-grade urothelial carcinoma (LGUC/HGUC) or benign. Interobserver agreement was calculated with Cohens kappa (κ) and diagnostic accuracy with 2 × 2 tables. Histopathology was the reference test.
RESULTS: Histopathology of 34 lesions revealed 14 HGUC, 14 LGUC and 6 benign tumors. Diagnostic yield for fCLE was 80-85% with a κ of 0.75. Respectively, sensitivity, specificity, NPV and PPV were: for benign tumors 0-20%, 96-100%, unmeasureable-50% and 87%, for LGUC 57-64%, 41-58%, 44-53% and 54-69% and for HGUC 38-57%, 56-68%, 38-57% and 56-68%, with an interobserver agreement of κ 0.61.
CONCLUSIONS: fCLE is currently insufficient to grade UCB.
METHODS: Participants scheduled for transurethral resection of papillary bladder tumors were prospectively included for intra-operative fCLE. Exclusion criteria were flat lesions, fluorescein allergy or pregnancy. Two independent observers evaluated fCLE, classifying tumors as low- or high-grade urothelial carcinoma (LGUC/HGUC) or benign. Interobserver agreement was calculated with Cohens kappa (κ) and diagnostic accuracy with 2 × 2 tables. Histopathology was the reference test.
RESULTS: Histopathology of 34 lesions revealed 14 HGUC, 14 LGUC and 6 benign tumors. Diagnostic yield for fCLE was 80-85% with a κ of 0.75. Respectively, sensitivity, specificity, NPV and PPV were: for benign tumors 0-20%, 96-100%, unmeasureable-50% and 87%, for LGUC 57-64%, 41-58%, 44-53% and 54-69% and for HGUC 38-57%, 56-68%, 38-57% and 56-68%, with an interobserver agreement of κ 0.61.
CONCLUSIONS: fCLE is currently insufficient to grade UCB.
摘要：
目的：膀胱上皮癌（UCB）的治疗需要频繁的膀胱镜检查和手术随访。共聚焦激光显微内窥镜（CLE）是一种基于探针的光学技术，可提供实时显微镜评估，具有门诊UCB分级的潜力。本研究旨在探讨柔性膀胱镜检查（fCLE）期间CLE对UCB分级的诊断准确性和观察者间差异。
方法：计划经尿道膀胱乳头状肿瘤切除术的参与者被前瞻性纳入术中fCLE。排除标准为扁平病变，荧光素过敏或怀孕。两名独立观察者评估了fCLE，将肿瘤分类为低级别或高级别尿路上皮癌（LGUC/HGUC）或良性。使用Cohenskappa（κ）计算观察者之间的一致性，并使用2×2表计算诊断准确性。组织病理学是参考测试。
结果：34个病变的组织病理学显示14个HGUC，14个LGUC和6个良性肿瘤。fCLE的诊断率为80-85%，κ为0.75。分别,灵敏度,特异性，NPV和PPV为:良性肿瘤0-20%,96-100%,无法测量-50%和87%，对于LGUC57-64%，41-58%，44-53%和54-69%，HGUC38-57%，56-68%，38-57％和56-68％，观察者之间的一致性为κ0.61。
结论：fCLE目前不足以对UCB进行分级。
方法：计划经尿道膀胱乳头状肿瘤切除术的参与者被前瞻性纳入术中fCLE。排除标准为扁平病变，荧光素过敏或怀孕。两名独立观察者评估了fCLE，将肿瘤分类为低级别或高级别尿路上皮癌（LGUC/HGUC）或良性。使用Cohenskappa（κ）计算观察者之间的一致性，并使用2×2表计算诊断准确性。组织病理学是参考测试。
结果：34个病变的组织病理学显示14个HGUC，14个LGUC和6个良性肿瘤。fCLE的诊断率为80-85%，κ为0.75。分别,灵敏度,特异性，NPV和PPV为:良性肿瘤0-20%,96-100%,无法测量-50%和87%，对于LGUC57-64%，41-58%，44-53%和54-69%，HGUC38-57%，56-68%，38-57％和56-68％，观察者之间的一致性为κ0.61。
结论：fCLE目前不足以对UCB进行分级。
