IBCN 2018: Multispectral Imaging Enables Multiparametric Cystoscopy and Transurethral Resection of Bladder Cancer

Rotterdam, The Netherlands (UroToday.com) Christian Bolenz presented his research using a real-time multispectral imaging (rMSI) device in bladder cancer patients. White light (WL) cystoscopy and transurethral resection (TUR) are the gold standard initial procedures for the detection and treatment of bladder cancer (BC). To overcome limited sensitivity of existing imaging techniques (e.g. PDD) they developed a real-time multispectral imaging (rMSI) device, enabling simultaneous imaging of reflectance and fluorescence modalities in up to 6 spectral bands.

Preclinical evaluation of rMSI included ex vivo and in vivo studies in porcine bladders. Different technical adaptions were required to meet standards for human cystoscopy. A pilot study in five patients who underwent TUR for BC was performed after instillation of HAL (Hexvix®) 1 hour before surgery. We used multiple LED light sources (Omicron-Laserage Laserprodukte GmbH) with different spectra to illuminate the bladder for fluorescence, NBI-like reflectance showing enhanced vascular contrast (EVC) and WL reflectance imaging. In a prospective cohort of 10 patients with bladder tumors they performed multiparametric (mp) cystoscopy with the rMSI device, simultaneously displaying six different modalities: WL, EVC, raw fluorescence, PDD-fluorescence, autofluorescence (AF) imaging, and merged mode.

Multispectral images were recorded in porcine endoscopy and subsequently in all patients with simultaneous bladder imaging in different modalities (WL, NBI-like and raw fluorescence mode, which is unmixed into PDD and AF). Merged multiparametric endoscopic images were created from the EVC and the raw fluorescence signal. Overall, 24 suspicious lesions were identified, 18 of which were diagnosed as malignant. Detection rates of malignant lesions were 14/18 in WL, 16/18 in PDD, 15/18 in EVC and 15/18 in AF, respectively. When combining all modalities all malignant lesions (18/18) were detected.

In summary, multiparametric cystoscopy with rMSI is feasible and may substantially enhance the performance of WL cystoscopy for the detection of BC. These results suggest that the distinct modalities may complement each other, enabling simultaneous real-time imaging with an increased sensitivity of cystoscopy.

Presented by: Christian Bolenz, Department of Urology, Bundeswehr Hospital Ulm, Ulm, Germany.

Written by: Stephen B. Williams, M.D., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 16th Annual Meeting of the International Bladder Cancer Network (IBCN) October 11-13, 2018 - the Inntel Hotels Rotterdam Centre, Rotterdam, The Netherlands
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