Purpose-We examined the utility and potential limitations of MEMS (Microelectro-mechanical systems) based spectral-domain cystoscopic optical coherence tomography (COCT) to improve the diagnosis of early bladder cancer.Materials and Methods-OCT catheter was integrated into the single instrument channel of a 22Fr cystoscope to permit white-light guided COCT over a large field of view of 4.6mm wide and 2.1mm deep per scan at 8 frames/s and 10um resolution. Intraoperative COCT diagnosis was performed in 56 patients, with a total of 110 lesions examined and compared with biopsied histology.Results-The overall sensitivity of COCT (94%) was significantly higher than cystoscopy (75%, p=0.02) and voided cytology (59%, p=0.005); the major enhancement over cystoscopy was for lowgrade pTa-1 cancer and carcinoma in situ (p<0.018). The overall specificity of COCT (81%) was comparable to voided cytology (88.9%, p=0.49), but significantly higher than cystoscopy (62.5%, p=0.02).
Conclusions-MEMS-basedCOCT, owing to its high resolution and detection sensitivity and large field of view, offers great potential for 'optical biopsy' to enhance the diagnosis of non-papillary bladder tumors and their recurrences and to guide bladder tumor resection.
General urological knowledge with regard to the primary care setting is insufficient. The potential for impact on patient care is enormous. These data highlight the need for a definitive urological curriculum in medical school as well as continued education at the resident and faculty level with regard to evaluation, management and recognition of when to request formal urological evaluation in the primary care setting.
The diverse embryological origins of the contents of the scrotum create an environment that fosters a wide variety of unusual pathologies. Most scrotal pathologies are discovered by the patient and are initially evaluated by a thorough physical examination and scrotal ultrasonography. Scrotal lesions can be broadly grouped by the anatomical location in which they develop; the clinician must consider a wide differential diagnosis based on this location. Solid testicular masses are considered germ cell tumors until proven otherwise, but numerous other possible pathologies exist, including ectopic tissue, metastasis, and other neoplastic growths. Rete testis lesions are classified as developmental, benign or malignant. Cystic lesions of the epididymis are most commonly benign, but malignant neoplasms can also be present. The paratesticular region has the broadest differential diagnosis, as it contains numerous distinct structures and is a common location for ectopic tissue and metastatic disease; a narrower range of lesions develop in the scrotal wall because of its simpler anatomy. Treatment options range from conservative observation to wide surgical excision and should be considered carefully; the aim of therapy is to remove malignant or potentially malignant tissue while minimizing effects on fertility and function.
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