Confocal laser endomicroscopy as a tool for intraoperative risk stratification of upper tract urothelial carcinoma

Martov A.G., Shoaydarov M.A., Dutov S.V., Andronov A.S., Zavarzin D.Yu.

1) Department of Urology and Andrology, Medical and Biological University of Innovation and Continuing Education, A.I. Burnazyan Federal Medical Biophysical Center, Federal Medical-Biological Agency of Russia, Moscow, Russia; 2) Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia; 3) Urological Center, Central Clinical Hospital of Civil Aviation, Moscow, Russia; 4) Department of Urology, Medical Institute of Continuing Education, ROSBIOTECH, Moscow, Russia

Aim. To evaluate the diagnostic value of probe-based confocal laser endomicroscopy (CLE) in upper tract urothelial carcinoma (UTUC) during ureteroscopy and to determine its potential role in intraoperative risk stratification and selection of patients for kidney-sparing treatment.
Materials and methods. From December 2019 to February 2023, CLE was performed in 17 patients with suspected UTUC. A Cellvizio system with a 0.85-mm (2.7 Ch) probe was used after intravenous administration of 10% sodium fluorescein. The obtained images were compared with the results of standard histopathological examination.
Results. CLE was technically feasible in all 17 patients. A total of 85 video sequences were obtained, with a mean of 5 per case. The mean examination time was 5 minutes, and the mean imaging time for a single area was 68 seconds. No complications were observed. UTUC was diagnosed in 15 patients, whereas inflammatory mucosal changes were found in 2. In all 15 patients with tumors, the CLE-based assessment was concordant with the final histopathological diagnosis: 7 tumors were high-grade and 8 were low-grade.
Conclusions. CLE is a safe and technically feasible method that allows real-time differentiation between low-grade and high-grade UTUC and may facilitate intraoperative decision-making between radical treatment and kidney-sparing treatment strategies.

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About the Authors

Corresponding author: A.G. Martov – Ph.D., MD, Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Urology and Andrology, Medical and Biological University of Innovation and Continuing Education, A.I. Burnazyan Federal Medical Biophysical Center, Federal Medical-Biological Agency of Russia; Leading Researcher, Department of Urology and Andrology, Medical Research and Educational Center, Lomonosov Moscow State University; Head of the Urological Center, Central Clinical Hospital of Civil Aviation; Professor, Department of Urology, Medical Institute of Continuing Education, ROSBIOTECH, Moscow, Russia; e-mail: martovalex@mail.ru

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