Next generation of optical diagnostics for bladder cancer using probebased confocal laser endomicroscopy

Jen Jane Liu, Timothy C. Chang, Ying Pan, Shelly T. Hsiao, Kathleen E. Mach, Kristin C. Jensen, Joseph C. Liao

Research output: Chapter in Book/Report/Conference proceedingConference contribution


Real-time imaging with confocal laser endomicroscopy (CLE) probes that fit in standard endoscopes has emerged as a clinically feasible technology for optical biopsy of bladder cancer. Confocal images of normal, inflammatory, and neoplastic urothelium obtained with intravesical fluorescein can be differentiated by morphologic characteristics. We compiled a confocal atlas of the urinary tract using these diagnostic criteria to be used in a prospective diagnostic accuracy study. Patients scheduled to undergo transurethral resection of bladder tumor underwent white light cystoscopy (WLC), followed by CLE, and histologic confirmation of resected tissue. Areas that appeared normal by WLC were imaged and biopsied as controls. We imaged and prospectively analyzed 135 areas in 57 patients. We show that CLE improves the diagnostic accuracy of WLC for diagnosing benign tissue, low and high grade cancer. Interobserver studies showed a moderate level of agreement by urologists and nonclinical researchers. Despite morphologic differences between inflammation and cancer, real-time differentiation can still be challenging. Identification of bladder cancer-specific contrast agents could provide molecular specificity to CLE. By using fluorescently-labeled antibodies or peptides that bind to proteins expressed in bladder cancer, we have identified putative molecular contrast agents for targeted imaging with CLE. We describe one candidate agent - anti-CD47 - that was instilled into bladder specimens. The tumor and normal urothelium were imaged with CLE, with increased fluorescent signal demonstrated in areas of tumor compared to normal areas. Thus, cancer-specificity can be achieved using molecular contrast agents ex vivo in conjunction with CLE.

Original languageEnglish (US)
Title of host publicationPhotonic Therapeutics and Diagnostics VIII
StatePublished - 2012
Externally publishedYes
EventPhotonic Therapeutics and Diagnostics VIII - San Francisco, CA, United States
Duration: Jan 21 2012Jan 24 2012

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
ISSN (Print)1605-7422


OtherPhotonic Therapeutics and Diagnostics VIII
Country/TerritoryUnited States
CitySan Francisco, CA


  • Bladder cancer diagnosis
  • Confocal laser endomicroscopy
  • In vivo imaging

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging


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