Non-muscle-invasive bladder cancer: a vision for the future

Figures & data

Table 1. Optical imaging technology to improve tumour detection as adjuncts to white-light cystoscopy (adapted from Zlatev et al., 2015 [15]).

Technology	Equipment	Mechanism	Field of view	Depth of view	Status
BLC	Standard rigid or flexible cystoscope + blue-light emitter	Fluorescence (requires exogenous contrast, e.g. HAL)	Broad	Surface	Clinical
NBI	Standard rigid or flexible cystoscope + light emitter	Light absorption	Broad	Surface	Clinical
SPIES	Standard rigid or flexible cystoscope + light emitter	Light absorption, digital enhancement	Broad	Surface	Investigational
OCT	Probe (2.7 mm)	Light scattering	Microscopic (10–20 μm)	∼2.5 mm	Investigational
Raman spectroscopy	Probe (2.1 mm)	Light scattering (± surface-enhancing nanoparticles)	Microscopic	2 mm	Investigational
CLE	Probe (0.85–2.6 mm)	Fluorescence (requires exogenous fluorescein)	Microscopic (1–3.5 μm)	120 μm	Investigational
Multiphoton microscopy	Scope/probe	Autofluorescence	Microscopic (∼1 μm)	0.5–1 mm	Investigational

BLC: blue-light cystoscopy; NBI: narrow-band imaging; SPIES: Storz Professional Image Enhancement System; OCT: optical coherence tomography; CLE: confocal laser endomicroscopy; HAL: hexaminolevulinate.

Figure 1. Current and proposed future management pathway for patients with non-muscle-invasive bladder cancer. CT: computed tomography; MRI: magnetic resonance imaging; WLC: white-light cystoscopy; BLC: blue-light cystoscopy; OCT: optical coherence tomography; RS: Raman spectroscopy; CLE: confocal laser endomicroscopy; TURB: transurethral resection of the bladder; EORTC: European Organisation for Research and Treatment of Cancer; CUETO: Club Urológico Español de Tratamiento Oncológico; MMC: mitomycin C; BCG: bacille Calmette–Guérin; FU: follow-up; WLFC: white-light flexible cystoscopy; BLFC: blue-light flexible cystoscopy.

Table 2. Technological advances to improve diagnosis, treatment and follow-up of patients with non-muscle-invasive bladder cancer.

Technology	Benefits
Non-invasive biomarker testing, including point-of-care urine tests	Rapid differential diagnosis, with high sensitivity and specificity for bladder cancer, identifying patients requiring further investigation
Advanced optical imaging tools, e.g. blue-light cystoscopy and narrow-band imaging	Accurate and complete visualization of the bladder to improve lesion detection and resection
“Red flag” imaging techniques such as optical coherence tomography, Raman spectroscopy, confocal laser endomicroscopy and multiphoton microscopy, in association with standardized pathology reporting	Detailed in vivo characterization of tumours (including staging and grading), providing precise risk classification to determine appropriate choice of treatment and follow-up schedule
Outpatient flexible cystoscopy using state-of-the-art technology, including blue-light guidance and laser treatment	Reduced burden of follow-up, as tumours are detected early and fulgurated or ablated immediately without the need for hospitalization and general anaesthesia
Follow-up schedules tailored to individual patients	Allowing intervals between visits to be extended where appropriate and minimizing the duration of follow-up in patients with the lowest risk of recurrence

Zlatev DV, Altobelli E, Liao JC. Advances in imaging technologies in the evaluation of high-grade bladder cancer. Urol Clin North Am 2015;42:147–57.

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