The Accuracy of Confocal Laser Endomicroscopy in Diagnosing Bladder Cancer: A Systematic Review & Meta-Analyses
Abstract
Background: Multiple advancements of endoscopic technology were designed to enhance the sensitivity and specificity of the diagnostic tools of bladder cancer; thus, we perform a meta-analysis to compare diagnostic performance between confocal laser endomicroscopy (CLE) and biopsy for detecting bladder cancer.
Methods: We compared CLE’s accuracy in diagnosing bladder cancer reported by studies obtained from the electronic database MEDLINE, CENTRAL, and CINAHL, from May to June 2020. The pooled effect estimate was calculated employing the DerSimonian and Laird random-effects model. We only included moderate to high-quality studies, which had been assessed by the QUADAS-2 tool.
Results: Eight studies were included in this review; five of those were good-quality studies. A total of 519 samples from 345 patients were included in the pooled effect estimate calculation. Pooled sensitivity and specificity of CLE in diagnosing bladder cancer were 90.2% (0.86, 0.93) and 78.1% (0.71, 0.85), respectively. The use of white-light cystoscopy (WLC) before CLE increased its specificity (56.8% versus 84.6%). Pooled sensitivity and specificity of CLE in predicting lowgrade lesion were 73% (0.66, 0.80) dan 83% (0.78, 0.87), respectively. Meanwhile, pooled sensitivity and specificity of CLE in predicting high-grade lesion were 73% (0.66, 0.78) and 79% (0.73, 0.83), respectively.
Conclusions: CLE has good accuracy in distinguishing malignant and benign tumors. Grading tumors with this modality is also accurate. The use of probe CLE (pCLE), coupled with WLC, will increase its specificity.
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DOI: 10.33371/ijoc.v15i4.804
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References
National Cancer Institute. Cancer stat facts: bladder cancer [Internet]. National Cancer Institute. 2020 [cited 2020 May 22]. Available from: https://seer.cancer.gov/statfacts/html/urinb.html
Cancer facts & figures 2019 [Internet]. 2019 [cited 2020 May 22]. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf
Wong MCS, Fung FDH, Leung C, et al. The global epidemiology of bladder cancer: a joinpoint regression analysis of its incidence and mortality trends and projection OPEN. Sci Rep. 2018;8:1129.
Miyazaki J, Nishiyama H. Epidemiology of urothelial carcinoma. Int J Urol. 2017;24(10):730–734.
Rezaianzadeh A, Mohammadbeigi A, Mobaleghi J, Mohammadsalehi N. Survival analysis of patients with bladder cancer, life table approach. J -Life Health. 2012;3(2):88–92.
Andreassen BK, Aagnes B, Gislefoss R, et al. Incidence and Survival of urothelial carcinoma of the urinary bladder in Norway 1981-2014. BMC Cancer. 2016;16(1):799.
Zhu C-Z, Ting H-N, Ng K-H, Ong T-A. A review on the accuracy of bladder cancer detection methods. J Cancer. 2019;10(17):4038–44.
Oude Elferink P, Witjes JA. Blue-light cystoscopy in the evaluation of non-muscle-invasive bladder cancer. Ther Adv Urol. 2014;6(1):25–33.
Shen Y-J, Zhu Y-P, Ye D-W, et al. Narrow-band imaging flexible cystoscopy in the detection of primary non-muscle invasive bladder cancer: a “second look” matters? Int Urol Nephrol. 2012;44(2):451–7.
Zlatev DV, Altobelli E, Liao JC. Advances in imaging technologies in the evaluation of high-grade bladder cancer. Urol Clin North Am. 2015;42(2):147–57.
Chen SP, Liao JC. Confocal laser endomicroscopy of bladder and upper tract urothelial carcinoma: a new era of optical diagnosis? Curr Urol Rep. 2014;15(9):437.
Knoedler JJ, Raman JD. Advances in the management of upper tract urothelial carcinoma: improved endoscopic management through better diagnostics. Ther Adv Urol. 2018;10(12):421-9.
Chang TC, Liu J-J, Hsiao ST, et al. Interobserver agreement of confocal laser endomicroscopy for bladder cancer. J Endourol. 2013;27(5):598–603.
Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;18;155(8):529–36.
Freund JE, Liem EIML, Savci-Heijink CD, Baard J, Kamphuis GM, de la Rosette JJMCH, et al. Confocal laser endomicroscopy for upper tract urothelial carcinoma: validation of the proposed criteria and proposal of a scoring system for real-time tumor grading. World J Urol. 2019;37(10):2155–64.
Lee J, Jeh SU, Koh DH, Chung DY, Kim MS, Goh HJ, et al. Probe-Based Confocal Laser Endomicroscopy During Transurethral Resection of Bladder Tumors Improves the Diagnostic Accuracy and Therapeutic Efficacy. Ann Surg Oncol. 2019;26(4):1158–65.
Liem EIML, Freund JE, Savci-Heijink CD, de la Rosette JJMCH, Kamphuis GM, Baard J, et al. Validation of confocal laser endomicroscopy features of bladder cancer: The next step towards real-time histologic grading. Eur Urol Focus. 2020;6(1):81–7.
Liu J-J, Chang TC, Pan Y, et al. Next generation of optical diagnostics for bladder cancer using probe-based confocal laser endomicroscopy. In: Photonic Therapeutics and Diagnostics VIII [Internet]. International Society for Optics and Photonics; 2012 [cited 2020 Jun 10]. p. 820716. Available from: https://www.spiedigitallibrary.org/conference-proceedings-of-spie/8207/820716/Next-generation-of-optical-diagnostics-for-bladder-cancer-using-probe/10.1117/12.907623.short
Liu J-J, Wu K, Adams W, et al. Real time diagnosis of bladder cancer with probe-based confocal laser endomicroscopy. In: Imaging, Manipulation, and Analysis of Biomolecules, Cells, and Tissues IX [Internet]. International Society for Optics and Photonics; 2011 [cited 2020 Jun 10]. p. 79021V. Available from: https://www.spiedigitallibrary.org/conference-proceedings-of-spie/7902/79021V/Real-time-diagnosis-of-bladder-cancer-with-probe-based-confocal/10.1117/12.874243.short
Lucas M, Liem EIML, Savci-Heijink CD, et al. Toward automated in vivo bladder tumor stratification using confocal laser endomicroscopy. J Endourol. 2019;33(11):930–7.
Marien A, Rock A, Maadarani KE, et al. Urothelial tumors and dual-band imaging: A new concept in confocal laser endomicroscopy. J Endourol. 2017;31(5):538–44.
Wu J, Wang Y-C, Dai B, et al. Optical biopsy of bladder cancer using confocal laser endomicroscopy. Int Urol Nephrol. 2019;51(9):1473–9.
Brunckhorst O, Ong QJ, Elson D, Mayer E. Novel real-time optical imaging modalities for the detection of neoplastic lesions in urology: a systematic review. Surg Endosc. 2019;33(5):1349–67.
Chen SP, Liao JC. Confocal laser endomicroscopy of bladder and upper tract urothelial carcinoma: A new era of optical diagnosis? Curr Urol Rep. 2014;15(9):437.
Ren H, Park KC, Pan R, et al. Early detection of carcinoma in situ of the bladder: a comparative study of white light cystoscopy, narrow band imaging, 5-ALA fluorescence cystoscopy and 3-dimensional optical coherence tomography. J Urol. 2012;187(3):1063–70.
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