EAU 2019: Ex Vivo Fluorescence Confocal Microscopy in the Assessment of Urothelial Carcinoma Grading in the Bladder and Ureter

Barcelona, Spain (UroToday.com) In this abstract, this multidisciplinary team from the University of Modena and Reggio in Emilia, Italy, presented their initial data on the utilization of fluorescence confocal microscopy.  This technique allows for optical evaluation in real time of freshly excised tissue.  It is currently in use in the evaluation of corneal diseases of the eye.  The group hypothesized that this technique can be used for ex vivo real-time identification and diagnosis of high versus low grade urothelial cancers in the bladder and ureter.  This following highlight represents the groups experience in their first four patients.

This data evaluated 6 specimens (5 bladder and 1 ureteral) from a total of 4 patients via transurethral resection and flexible ureteroscopy.  The specimens were evaluated ex vivo utilizing the Mavig 2500 VIVASCOPE® and also by the center’s GU pathologist, who was blinded.  Histopathologic results were compared between the fluorescence confocal microscopy and the standard pathologic review.

Technically, all digital fluorescence confocal microscopy were available within 5 minutes.  All 6 of the specimens had 100% concordance between the fluorescence confocal microscopy grading and the final histopathology.  Of note, 4 of the specimens were high grade (1 ureteral and 3 bladder) and 2 of the specimens were low grade (2 bladder).

This introductory study demonstrates a promising technique in the histopathologic evaluation of urothelial cancers.  In the future, it may be utilized for assistance in recommending peri-operative intravesical chemotherapy.  We are interested in seeing what the future holds for this emerging technique.  Hopefully, urologists can find other applications to use fluorescence confocal microscopy to help with real time diagnosis in other malignancies.  

Presented by: Stefano Puliatti, MD, Department of Urology University of Modena & Reggio Emilia, Modena, Italy

Written by: David B. Cahn, DO, MBS, @dbcahn, Fox Chase Cancer Center at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain, March 15-19, 2019.