Staging of upper tract urothelial cancer with optical coherence tomography

Summary

Principal Investigator: Hui Zhu
Abstract: DESCRIPTION (provided by applicant): Diagnosis and treatment of upper-tract urothelial carcinomas (UTUC) remain very challenging for urologists. Standard management for many years has been radical nephroureterectomy (RNU). However, RNU is a significant over-treatment for low-risk tumors, which have low rate of progression. Endoscopic management of these low-risk cases bears obvious advantages over RNU, including lower co-morbidity and lower cost, and would be highly feasible if accurate diagnosis can be made. The success of endoscopic management relies on accurate identification of low-grade and low-stage tumors, but staging of UTUC is very difficult even through biopsy. Usually, adequate tissue specimens for pathohistological staging cannot be acquired because of the limited manipulation space in the ureter and renal pelvis and the potential risk of perforating thin ureteral wall if deep biopsyis attempted. Therefore, urologists typically make a diagnosis only based on the tumor grade, which is also inefficient because of the limitations of biopsy, and which, alone, is not sufficientto make certain treatment decisions. Therefore, if the stage of UTUC could be safely and reliably identified, urologists would have complete information for diagnosis, which could significantly improve endoscopic management of UTUC. We propose to stage UTUC through endoscopic optical coherence tomography (OCT). The feasibility of this in situ imaging approach is supported by the fact that OCT has already been shown to be able to stage bladder urothelial cancer, which is histologically similar to UTUC and uses the same staging system as UTUC. We have demonstrated that OCT can acquire high-quality images of the ureter through a probe ex vivo. In this project, we will implement OCT probes specifically for imaging of UTUC and test the safety and preliminary efficacy of staging of UTUC in a two-stage pilot study, including a training stage and a testing stage. Success of this project will result in: (a) an endoscopic OCT system designed and proven safe for UTUC imaging, (b) tested OCT image-based diagnostic criteria, and (c) a preliminary estimate of the accuracy of OCT staging of UTUC. This will justify and set the stage for larger scale clinical validation.
Funding Period: 2012-09-17 - 2014-08-31
more information: NIH RePORT

Detail Information

Research Grants30

  1. Intraoperative Label-Free Optical Molecular Imaging of Breast Tumor Margins
    Stephen A Boppart; Fiscal Year: 2013
    ..Although the intraoperative imaging by NIVI in breast cancer surgery is the main focus of this project, we envision that this technique will benefit many other areas of surgical oncology. ..
  2. Mechanisms and Markers of Prostate Cancer Metastases
    ROBERT LOUIS VESSELLA; Fiscal Year: 2013
    ..It also conducts pre-clinical xenograft studies and provides statistical support to the overall P01 program. Core B is the Administrative Core which provides overall administrative support to the investigators. ..
  3. Spatially Offset Raman Spectroscopy for Mohs Micrographic Surgical Guidance
    ISAAC JAMES PENCE; Fiscal Year: 2013
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  4. Sutureless Laparoscopic Partial Nephrectomy Using Laser Tissue Welding: Preclinic
    Yasmin Wadia; Fiscal Year: 2013
    ..Fibro-optic capable: Minimally invasive laparoscopic &robotic applications. ..
  5. Transnasal Probe for Diagnosing Eosinophilic Esophagitis
    Guillermo J Tearney; Fiscal Year: 2013
    ..Beyond its immediate clinical impact, this technology can also be used in future investigational studies to expand our knowledge of EoE and other diseases such as asthma that are characterized by tissue eosinophilia. ..
  6. ROLES AND REGULATION OF P53
    Carol Prives; Fiscal Year: 2013
    ..The projects are even more interdependent and interactive than before and as a result much of the proposed research cannot be done effectively without the support of this program. ..
  7. Quantitative Photoacoustic Detection of Lymph-node Metastases
    ERNEST JOSEPH FELEPPA; Fiscal Year: 2013
    ..These methods also may be of use in evaluations of non-cancerous diseases such as cardiac disease, musculoskeletal disease, etc. ..
  8. Reducing Cervical Cancer in Appalachia
    Electra D Paskett; Fiscal Year: 2013
    ..Future work of this Center will focus on moving this type of multi-level observational and interventional community-based research, into other areas where health disparities exist in relation to cancer withinour region. ..
  9. Functional Annotation of the Pancreatic Cancer Genome
    Steven D Leach; Fiscal Year: 2013
    ..Together, these studies will dramatically accelerate the functional annotation of the pancreatic cancer genome, setting the stage for future therapeutic applications. ..
  10. Characterization of Pathways Controlling Cancer at the Level of Gene Regulation
    Phillip A Sharp; Fiscal Year: 2013
    ..The interactions and involvement of Rb and miRNAs in induction of cell death following DNA damage will also be studied. ..
  11. Improving Screening and Surveillance in Barrett's Patients
    Guillermo J Tearney; Fiscal Year: 2013
    ..In the end, we will have developed and validated an improved screening tool for BE that is less expensive and more accurate than the current standard of care. ..
  12. UNMC EPPLEY CANCER CENTER SUPPORT GRANT
    Kenneth H Cowan; Fiscal Year: 2013
    ....
  13. Prostate-cancer Imaging by Combined Ultrasound and Magnetic-resonance Parameters
    ERNEST JOSEPH FELEPPA; Fiscal Year: 2013
    ..Successfully generating reliable prostate TTIs based on combined US and MR parameters will represent a quantum advance in PCa management by enabling significant improvements in the diagnosis and treatment of PCa. ..
  14. Mucosal Immunity, Vaccines and Microbiota Interplay in Humans and Animal
    Marcelo B Sztein; Fiscal Year: 2013
    ..Given the shortcomings of available measures to successfully control this infection, and its bioterrorism potential, to develop a S. dysenteriae type 1 vaccine is of great importance. ..