Urothelial Tumors and Dual-Band Imaging: A New Concept in Confocal Laser Endomicroscopy.
Confocal laser endomicroscopy (CLE) uses a low-energy laser light source to obtain microscopic histology images of bladder tissue exposed to a fluorescent dye. To evaluate the feasibility of using CLE with two fluorophores: fluorescein (FLUO) and hexylaminolevulinate (HAL) to determine histologic and cytologic bladder cancer criteria.



Patients eligible for HAL-photodynamic diagnosis-assisted transurethral resection of bladder tumor were included. The procedures were performed with the patient under regional or general anesthesia (60-90 minutes) after bladder instillation of HAL (50 mL, 8 mmol/L; Hexvix®; Ipsen, France). Resected tissue was examined ex vivo using CLE either with Cellvizio®system (CVI) single laser (488 nm) or with Cellvizio Dual system (CVII) double laser (488, 660 nm).



Twenty-one patients were included, 12 examined by CVI and 9 by CVII. Sample examination on CVI after HAL-CLE-only histologic analysis was not possible because HAL is mostly cytoplasmic and gives poor details on cellular architecture. On the contrary, FLUO-CLE gives good extracellular architecture and not clear information of nucleocytoplasmic abnormality. Samples on CVII for seven out of nine patients clearly showed cytoplasm of suspect cells and nuclei. In real time, fluorescence observed on bandwidth (673-800 nm) with HAL and FLUO was associated with the presence of cancer, with a sensibility and specificity of 80% and 100%, respectively.



Real-time cytodetection was feasible using two fluorophores (FLUO and HAL) and the new system of CVII. This technology was useful to observe cytoplasm, nuclei, and nucleocytoplasmic abnormality, but an improved system is necessary (to overcome the overlapping of fluorescence) to increase the specificity.
1 Department of Urology, Groupe Hospitalier de l'Institut Catholique Lillois , Faculté Libre de Médecine, Lille, France .
Arnaud
A
Marien
1 Department of Urology, Groupe Hospitalier de l'Institut Catholique Lillois , Faculté Libre de Médecine, Lille, France .
Aurélien
A
Rock
1 Department of Urology, Groupe Hospitalier de l'Institut Catholique Lillois , Faculté Libre de Médecine, Lille, France .
Khaled El
KE
Maadarani
1 Department of Urology, Groupe Hospitalier de l'Institut Catholique Lillois , Faculté Libre de Médecine, Lille, France .
Catherine
C
Francois
2 Department of Pathology and Cytology, Groupe Hospitalier de l'Institut Catholique Lillois , Faculté Libre de Médecine, Lille, France .
Pierre
P
Gosset
1 Department of Urology, Groupe Hospitalier de l'Institut Catholique Lillois , Faculté Libre de Médecine, Lille, France .
Brigitte
B
Mauroy
1 Department of Urology, Groupe Hospitalier de l'Institut Catholique Lillois , Faculté Libre de Médecine, Lille, France .
Jean-Louis
JL
Bonnal
D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000737:chemistry; D002467:Cell Nucleus / Q000378:metabolism; D003430:Cross-Sectional Studies; D003593:Cytoplasm / Q000378:metabolism; D003936:Diagnosis, Computer-Assisted; D005260:Female; D019793:Fluorescein / Q000737:chemistry; D005453:Fluorescence; D005456:Fluorescent Dyes; D005602:France; D006801:Humans; D007834:Lasers; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery
D005456:Fluorescent Dyes; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester; D019793:Fluorescein
Cellvizio; confocal; dual band; microscopy; optical biopsy; urinary tract urothelial carcinoma