Real time diagnosis of bladder cancer with probe-based confocal laser endomicroscopy

Jen Jane Liu, Katherine Wu, Winifred Adams, Shelly T. Hsiao, Kathleen E. Mach, Andrew H. Beck, Kristin C. Jensen, Joseph C. Liao

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


Probe-based confocal laser endomicroscopy (pCLE) is an emerging technology for in vivo optical imaging of the urinary tract. Particularly for bladder cancer, real time optical biopsy of suspected lesions will likely lead to improved management of bladder cancer. With pCLE, micron scale resolution is achieved with sterilizable imaging probes (1.4 or 2.6 mm diameter), which are compatible with standard cystoscopes and resectoscopes. Based on our initial experience to date (n = 66 patients), we have demonstrated the safety profile of intravesical fluorescein administration and established objective diagnostic criteria to differentiate between normal, benign, and neoplastic urothelium. Confocal images of normal bladder showed organized layers of umbrella cells, intermediate cells, and lamina propria. Low grade bladder cancer is characterized by densely packed monomorphic cells with central fibrovascular cores, whereas high grade cancer consists of highly disorganized microarchitecture and pleomorphic cells with indistinct cell borders. Currently, we are conducting a diagnostic accuracy study of pCLE for bladder cancer diagnosis. Patients scheduled to undergo transurethral resection of bladder tumor are recruited. Patients undergo first white light cystocopy (WLC), followed by pCLE, and finally histologic confirmation of the resected tissues. The diagnostic accuracy is determined both in real time by the operative surgeon and offline after additional image processing. Using histology as the standard, the sensitivity, specificity, positive and negative predictive value of WLC and WLC + pCLE are calculated. With additional validation, pCLE may prove to be a valuable adjunct to WLC for real time diagnosis of bladder cancer.

Original languageEnglish (US)
Title of host publicationImaging, Manipulation, and Analysis of Biomolecules, Cells, and Tissues IX
StatePublished - 2011
Externally publishedYes
EventImaging, Manipulation, and Analysis of Biomolecules, Cells, and Tissues IX - San Francisco, CA, United States
Duration: Jan 22 2011Jan 25 2011

Publication series

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


OtherImaging, Manipulation, and Analysis of Biomolecules, Cells, and Tissues IX
Country/TerritoryUnited States
CitySan Francisco, CA


  • Confocal laser endomicroscopy
  • bladder cancer diagnosis
  • 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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