Moderne endoskopische Bildgebungsverfahren für das Urothelkarzinom der Harnblase

 

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Zusammenfassung

Die primäre Diagnostik und Therapie des Urothelkarzinoms (UCC) der Harnblase erfolgt endoskopisch. Eine möglichst sichere Differenzierung zwischen benignen Läsionen und maligne entartetem Urothel ist erforderlich. Die Weißlichtzystoskopie gilt als Goldstandard, jedoch bestehen Limitationen bei der Detektion kleiner Tumore und des Carcinoma in situ. Mit der Photodyamischen Diagnostik (PDD) und dem Narrow Band Imaging (NBI) stehen zwei klinisch etablierte Techniken zur Verfügung, die die Detektionsrate verbessern und die Rezidivrate eines Urothelkarzinoms senken können. Das Storz Professional Imaging Enhancement System (SPIES) beruht auf einer digitalen Kontrastverstärkung und wird aktuell in klinischen Studien evaluiert. Mit der konfokalen Laser-Endomikroskopie (CLE) wird das Prinzip der optischen Biopsie verfolgt. Sie erlaubt bereits intraoperativ die Darstellung des Gewebes mit einer der Lichtmikroskopie vergleichbaren Auflösung. Die optische Kohärenztomografie (OCT) stellt intraoperativ Querschnittsbilder der Harnblasenwand dar und liefert Informationen zur Eindringtiefe des Tumors. Eine weitere Ergänzung ist die Raman-Spektroskopie, die über Spektralanalysen die Beurteilung der Zusammensetzung von Material und Gewebe erlaubt. Die zunehmende molekulare Entschlüsselung des Urothelkarzinoms der Harnblase bietet neue Chancen für die Endoskopie. In Zukunft werden moderne Fotosensibilisatoren über molekulare Zielstrukturen spezifisch an Urothelkarzinomzellen binden, um malignes Gewebe sensitiver zu detektieren. Softwarebasierte Bildgebungsmodalitäten bieten neben der Unterstützung bei der Interpretation von endoskopischen Bildern diverse Möglichkeiten für eine verbesserte digitale Befunddokumentation und -kommunikation. Die vorliegende Arbeit stellt die modernen endoskopischen Bildgebungsverfahren vor und diskutiert deren potenziellen klinischen Nutzen.

Abstract

Cystoscopy is the gold standard for the initial diagnosis of urothelial carcinoma in the urinary bladder (UCB). White light exhibits significant limitations in its ability to detect flat lesions or carcinoma in situ. Photodynamic Diagnosis (PDD) and Narrow Band Imaging (NBI) are established techniques which may improve the detection rates of UCB and reduce the risk of recurrence. Multiple novel tools have been developed in order to improve the diagnostic accuracy of endoscopic procedures, including Digital Contrast Enhancement Technology, Confocal Laser Endomicroscopy (CLE) and Optical Coherence Tomography (OCT). In future, spectral analysis of urothelial lesions may be achieved by Raman spectroscopy, thus providing information about biological alterations in the tissue. Furthermore, molecular imaging may allow specific targeting by fluorescent antibodies or small molecule agents, thus enabling differential diagnosis of suspicious lesions. Software-based approaches have been developed to incorporate computer-aided diagnosis and improve digital documentation of endoscopic findings. This study reviews current and future developments in the field of modern endoscopy of the urinary bladder and discusses the different approaches.

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