title: Multiphoton microscopy in the evaluation of human bladder biopsies.
abstract: BACKGROUND
  Multiphoton microscopy (MPM) is a nonlinear imaging approach, providing cellular and subcellular details from fresh (unprocessed) tissue by exciting intrinsic tissue emissions. With miniaturization and substantially decreased cost on the horizon, MPM is an emerging imaging technique with many potential clinical applications.
  
  
  OBJECTIVE
  To assess the imaging ability and diagnostic accuracy of MPM for human bladder biopsies.
  
  
  METHODS
  Seventy-seven fresh bladder biopsies were imaged by MPM and subsequently submitted for routine surgical pathology diagnosis. Twelve cases were excluded because of extensive cautery artifact that prohibited definitive diagnosis. Comparison was made between MPM imaging and gold standard sections for each specimen stained with hematoxylin-eosin.
  
  
  RESULTS
  In 57 of 65 cases (88%), accurate MPM diagnoses (benign or neoplastic) were given based on the architecture and/or the cytologic grade. The sensitivity and specificity of MPM in our study were 90.4% and 76.9%, respectively. A positive (neoplastic) diagnosis on MPM had a high predictive value (94%), and negative (benign) diagnoses were sustained on histopathology in two-thirds of cases. Architecture (papillary versus flat) was correctly determined in 56 of 65 cases (86%), and cytologic grade (benign/low grade versus high grade) was assigned correctly in 38 of 56 cases (68%).
  
  
  CONCLUSIONS
  The MPM images alone provided sufficient detail to classify most lesions as either benign or neoplastic using the same basic diagnostic criteria as histopathology (architecture and cytologic grade). Future developments in MPM technology may provide urologists and pathologists with additional screening and diagnostic tools for early detection of bladder cancer. Additional applications of such emerging technologies warrant exploration.
authors.affiliation: Department of Urology, Weill Cornell Medical College, 1300 York Avenue, NewYork, NY 10065, USA.
authors.forename: Manu
authors.initials: M
authors.lastname: Jain
authors.forename: Brian D
authors.initials: BD
authors.lastname: Robinson
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Joshua
authors.initials: J
authors.lastname: Sterling
authors.forename: Ming-Ming
authors.initials: MM
authors.lastname: Lee
authors.forename: James
authors.initials: J
authors.lastname: Wysock
authors.forename: Mark A
authors.initials: MA
authors.lastname: Rubin
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Maxfield
authors.forename: Warren R
authors.initials: WR
authors.lastname: Zipfel
authors.forename: Watt W
authors.initials: WW
authors.lastname: Webb
authors.forename: Sushmita
authors.initials: S
authors.lastname: Mukherjee
mesh_terms: D000328:Adult; D001706:Biopsy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D036641:Microscopy, Fluorescence, Multiphoton / Q000379:methods*; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*