New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.24915/aup.35.3-4.91 |
Resumo: | Upper tract urothelial carcinoma (UTUC) is uncommon, but most cases are invasive at diagnosis. Standard of care in patients with UTUC is radical nephroureterectomy (RNU), but low risk UTUC can be treated with kidney sparing surgery (KSS) without compromising oncological outcomes. Current diagnostic techniques have many limitations on UTUC diagnosis, mainly in the detection of carcinoma in situ (CIS), a flat, high grade lesion with high progression risk. Therefore, investigating new diagnostic techniques which allow earlier detection of UTUC lesions has become a relevant matter. This review provides an overview of the new imaging diagnostic techniques currently available for UTUC diagnosis. A PubMed literature search was performed and articles on narrow band imaging (NBI), Image1 S, photodynamic diagnosis (PDD), confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) were reviewed. Six articles were selected for review, all of them referring to in vivo human studies. There were no articles on Image1 S. All techniques are compatible with existing flexible ureterorenoscopes. NBI, Image1 S and PDD aim at improving UTUC detection. CLE and OCT aim at providing minimally invasive and real-time histopathological diagnostic. Either NBI or PDD show a better lesion detection rate in comparison with conventional flexible ureterorenoscopy (FURS), but only PDD has shown a better CIS detection. CLE can differentiate healthy from malignant urothelium and high grade lesions from low grade ones. However, it does not allow staging. OCT shows higher UTUC staging and grading sensitivity than biopsy, but lesions greater than 2 mm can cause false-positives. Combining FURS with new diagnostic techniques could improve its diagnostic precision and capability to properly select KSS candidates. Further research needs to be conducted to validate these new diagnostic techniques on the UTUC diagnosis. |
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New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial CarcinomaNovas Técnicas Endoscópicas de Diagnóstico do Carcinoma Urotelial do Trato Urinário SuperiorImage EnhancementUrinary Tract/diagnostic imagingUrologic Neoplasms/diagnostic imagingAumento da ImagemNeoplasias Urológicas/ diagnóstico por imagemSistema Urinário/diagnóstico por imagemUpper tract urothelial carcinoma (UTUC) is uncommon, but most cases are invasive at diagnosis. Standard of care in patients with UTUC is radical nephroureterectomy (RNU), but low risk UTUC can be treated with kidney sparing surgery (KSS) without compromising oncological outcomes. Current diagnostic techniques have many limitations on UTUC diagnosis, mainly in the detection of carcinoma in situ (CIS), a flat, high grade lesion with high progression risk. Therefore, investigating new diagnostic techniques which allow earlier detection of UTUC lesions has become a relevant matter. This review provides an overview of the new imaging diagnostic techniques currently available for UTUC diagnosis. A PubMed literature search was performed and articles on narrow band imaging (NBI), Image1 S, photodynamic diagnosis (PDD), confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) were reviewed. Six articles were selected for review, all of them referring to in vivo human studies. There were no articles on Image1 S. All techniques are compatible with existing flexible ureterorenoscopes. NBI, Image1 S and PDD aim at improving UTUC detection. CLE and OCT aim at providing minimally invasive and real-time histopathological diagnostic. Either NBI or PDD show a better lesion detection rate in comparison with conventional flexible ureterorenoscopy (FURS), but only PDD has shown a better CIS detection. CLE can differentiate healthy from malignant urothelium and high grade lesions from low grade ones. However, it does not allow staging. OCT shows higher UTUC staging and grading sensitivity than biopsy, but lesions greater than 2 mm can cause false-positives. Combining FURS with new diagnostic techniques could improve its diagnostic precision and capability to properly select KSS candidates. Further research needs to be conducted to validate these new diagnostic techniques on the UTUC diagnosis.O carcinoma urotelial do trato superior (CUTS) é raro, mas a maioria dos casos apresenta-se invasiva ao diagnóstico. O tratamento padrão do CUTS consiste na nefroureterectomia radical. No entanto, os CUTS de baixo risco podem ser abordados com cirurgia poupadora de nefrónios (CPN), sem compromisso do prognóstico oncológico. As técnicas de diagnóstico atuais apresentam várias falhas no diagnóstico de CUTS, principalmente na deteção de carcinoma in situ (CIS), uma lesão plana, de alto grau e com elevado risco de progressão. Assim, torna-se pertinente a investigação de novas técnicas de diagnóstico capazes de detetar as lesões de CUTS numa fase mais precoce. Esta revisão procura analisar o desempenho das novas técnicas de imagem disponíveis para o diagnóstico do CUTS. Foi conduzida uma pesquisa da literatura atual na base de dados PubMed e foram revistos artigos sobre a narrow band imaging (NBI), Image1 S, diagnóstico fotodinâmico (DFD), confocal laser endomicroscopy (CLE) e optical coherence tomography (OCT). Foram selecionados seis artigos para revisão, todos referentes a estudos in vivo em humanos. Não foi encontrado nenhum artigo sobre o Image1 S. Todas as técnicas descritas são compatíveis com os ureterorrenoscópios flexíveis atuais. A NBI, o Image1 S e o DFD visam uma melhor deteção do CUTS. A CLE e a OCT visam a caracterização histopatológica e minimamente invasiva das lesões, em tempo real. Quer a NBI, quer o DFD apresentam melhor taxa de deteção das lesões em comparação com a ureterorrenoscopia flexível (URSF) convencional, mas apenas o DFD mostrou melhor deteção de CIS. A CLE permite distinguir o urotélio saudável do maligno e as lesões de baixo grau das de alto grau. No entanto, não avalia o estadiamento. A OCT apresenta maior sensibilidade do que a biópsia para o estadiamento e gradação do CUTS, mas as lesões com mais de 2 mm de espessura podem gerar diagnósticos falsos-positivos. A combinação da URSF com uma ou várias das novas técnicas de diagnóstico poderia aumentar a sua precisão diagnóstica e capacidade de selecionar adequadamente os candidatos para CPN. São necessários mais estudos que validem a utilização das novas técnicas no diagnóstico de CUTS.Associação Portuguesa de Urologia2019-01-19T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.24915/aup.35.3-4.91oai:oai.actaurologicaportuguesa.com:article/91Acta Urológica Portuguesa; Vol. 35 No. 3-4 (2018): July-September; October-December; 25-32Acta Urológica Portuguesa; v. 35 n. 3-4 (2018): Julho-Setembro; Outubro-Dezembro; 25-322387-04192341-4022reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttp://www.actaurologicaportuguesa.com/index.php/aup/article/view/91https://doi.org/10.24915/aup.35.3-4.91http://www.actaurologicaportuguesa.com/index.php/aup/article/view/91/44Copyright (c) 2018 Portuguese Association of Urologyinfo:eu-repo/semantics/openAccessVieira, Maria TeresaCavadas, Vítor2022-09-21T09:04:48Zoai:oai.actaurologicaportuguesa.com:article/91Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T15:55:54.367056Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma Novas Técnicas Endoscópicas de Diagnóstico do Carcinoma Urotelial do Trato Urinário Superior |
title |
New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma |
spellingShingle |
New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma Vieira, Maria Teresa Image Enhancement Urinary Tract/diagnostic imaging Urologic Neoplasms/diagnostic imaging Aumento da Imagem Neoplasias Urológicas/ diagnóstico por imagem Sistema Urinário/diagnóstico por imagem |
title_short |
New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma |
title_full |
New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma |
title_fullStr |
New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma |
title_full_unstemmed |
New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma |
title_sort |
New Diagnostic Endoscopic Techniques for Upper Urinary Tract Urothelial Carcinoma |
author |
Vieira, Maria Teresa |
author_facet |
Vieira, Maria Teresa Cavadas, Vítor |
author_role |
author |
author2 |
Cavadas, Vítor |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Vieira, Maria Teresa Cavadas, Vítor |
dc.subject.por.fl_str_mv |
Image Enhancement Urinary Tract/diagnostic imaging Urologic Neoplasms/diagnostic imaging Aumento da Imagem Neoplasias Urológicas/ diagnóstico por imagem Sistema Urinário/diagnóstico por imagem |
topic |
Image Enhancement Urinary Tract/diagnostic imaging Urologic Neoplasms/diagnostic imaging Aumento da Imagem Neoplasias Urológicas/ diagnóstico por imagem Sistema Urinário/diagnóstico por imagem |
description |
Upper tract urothelial carcinoma (UTUC) is uncommon, but most cases are invasive at diagnosis. Standard of care in patients with UTUC is radical nephroureterectomy (RNU), but low risk UTUC can be treated with kidney sparing surgery (KSS) without compromising oncological outcomes. Current diagnostic techniques have many limitations on UTUC diagnosis, mainly in the detection of carcinoma in situ (CIS), a flat, high grade lesion with high progression risk. Therefore, investigating new diagnostic techniques which allow earlier detection of UTUC lesions has become a relevant matter. This review provides an overview of the new imaging diagnostic techniques currently available for UTUC diagnosis. A PubMed literature search was performed and articles on narrow band imaging (NBI), Image1 S, photodynamic diagnosis (PDD), confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) were reviewed. Six articles were selected for review, all of them referring to in vivo human studies. There were no articles on Image1 S. All techniques are compatible with existing flexible ureterorenoscopes. NBI, Image1 S and PDD aim at improving UTUC detection. CLE and OCT aim at providing minimally invasive and real-time histopathological diagnostic. Either NBI or PDD show a better lesion detection rate in comparison with conventional flexible ureterorenoscopy (FURS), but only PDD has shown a better CIS detection. CLE can differentiate healthy from malignant urothelium and high grade lesions from low grade ones. However, it does not allow staging. OCT shows higher UTUC staging and grading sensitivity than biopsy, but lesions greater than 2 mm can cause false-positives. Combining FURS with new diagnostic techniques could improve its diagnostic precision and capability to properly select KSS candidates. Further research needs to be conducted to validate these new diagnostic techniques on the UTUC diagnosis. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-01-19T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.24915/aup.35.3-4.91 oai:oai.actaurologicaportuguesa.com:article/91 |
url |
https://doi.org/10.24915/aup.35.3-4.91 |
identifier_str_mv |
oai:oai.actaurologicaportuguesa.com:article/91 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
http://www.actaurologicaportuguesa.com/index.php/aup/article/view/91 https://doi.org/10.24915/aup.35.3-4.91 http://www.actaurologicaportuguesa.com/index.php/aup/article/view/91/44 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2018 Portuguese Association of Urology info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2018 Portuguese Association of Urology |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Associação Portuguesa de Urologia |
publisher.none.fl_str_mv |
Associação Portuguesa de Urologia |
dc.source.none.fl_str_mv |
Acta Urológica Portuguesa; Vol. 35 No. 3-4 (2018): July-September; October-December; 25-32 Acta Urológica Portuguesa; v. 35 n. 3-4 (2018): Julho-Setembro; Outubro-Dezembro; 25-32 2387-0419 2341-4022 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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