Study shows benefit of confocal laser endomicroscopy for urology

APRIL 27, 2009--According to new data presented today at the American Urological Association's (AUA) Annual meeting, real-time, in vivo confocal endomicroscopy may help urologists to differentiate low and high-grade bladder tumors from normal bladder tissue. Mauna Kea Technologies' (Paris, France) Cellvizio, a probe-based confocal laser endomicroscopy (pCLE) system that provides live images of internal human tissues at the cellular level, is the subject of the work.

"With additional clinical investigation and further technological innovation, pCLE could provide a useful adjunct to white light cystoscopy in bladder cancer diagnosis and streamline patient management," says Joseph Liao, Assistant Professor of Urology at Stanford University and Chief of Urology at Veterans Affairs Palo Alto Health Care System, who led the investigation. "Adding pCLE may potentially improve the yield of bladder biopsy in some patients while avoiding unnecessary biopsy in others."

The data were derived from research on 27 patients; the study represents the first in vivo microscopic evaluation of the human bladder using micro endoscopic technology and demonstrates that healthy and cancerous tissue may be differentiated in real time. It found that normal urothelium was characterized by a network of regular polygonal-shaped cells, with superficial umbrella cells larger than deeper intermediate cells. Meanwhile, high-grade tumors had much more architectural irregularity and cellular pleomorphism.

"This study shows real promise for the introduction of pCLE in the field of urology," said Sacha Loiseau, Founder, President and CEO of Mauna Kea Technologies. "These findings demonstrate Cellvizio's potential to impact how physicians diagnose and treat cancer and diseases in the urinary tract, just as we've seen in the gastrointestinal tract and lungs"

The study, titled "Optical Biopsy of Human Bladder Neoplasia with In Vivo Confocal Laser Endomicroscopy," was conducted under an institutional review board (IRB)- approved protocol and is registered on clinicaltrials.gov.

Bladder cancer is one of the most commonly diagnosed cancers (4th in men and 8th in women), with more than 60,000 new cases per year in the United States. "There is a significant need for more sensitive and specific, less invasive, and cost effective diagnostic modality for bladder cancer," Dr. Liao said. "There is considerable interest in the urologic community to improve the diagnostic accuracy of white light cystoscopy, as evidenced by interests in imaging modalities such as fluorescence cystoscopy and optical coherence tomography. However, significant hurdles remain regarding the diagnostic specificity and the image resolution of these novel techniques. pCLE is an optical imaging modality that may bridge the shortcomings of the other imaging modalities and provide an important clinical utility for in vivo diagnostics."

Cellvizio, "the world's smallest microscope," aims to enable faster clinical decision making during examination procedures.

Learn more about the study, Fiber-Optic Confocal Microscopy of the Urinary Tract Histopathology, at clinicaltrials.gov. For more information about the maker of the Cellvizio pCLE system, visit Mauna Kea Technologies' site. And, find details on the American Urological Association's (AUA) Annual meeting, which is taking place in Chicago April 25-30.

Posted by Barbara G. Goode, barbarag@pennwell.com, for BioOptics World.

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