High Resolution Imaging for Early and Better Detection of Bladder Cancer
Funding Agency:
Cancer Prevention and Research Institute of Texas
Collaborators:
Rebecca Richards-Kortum (Rice), Richard Schwarz (Rice), Nadeem Dhanani (UT Health Science Center Houston)
Overview:
Bladder cancer is the 6th most common cancer in the US. When detected early, bladder cancer can be treated successfully. Unfortunately, bladder cancer has a very high rate of recurrence, and as a result, is the most expensive cancer to treat. Bladder cancer is initially diagnosed during endoscopy. Because of the high risk of recurrence, patients who have been treated for bladder cancer undergo follow-up endoscopy every 3-6 months. Standard endoscopy has a number of shortcomings; some flat cancers are hard to visualize during endoscopy and are not detected at the earliest stage when they are most easily and effectively treated. At the same time, it is difficult for physicians to tell whether lesions that appear suspicious contain cancer or are benign, and so all lesions must be biopsied. It is especially difficult to visualize recurrent cancers using standard endoscopy, because lesions are flat and appear similar to other benign changes.
Thus, there is an important need to improve the ability of white light cystoscopy to: (1) identify bladder lesions with high sensitivity, and (2) characterize them as benign or malignant with high specificity. Improved endoscopy techniques such as narrow band imaging and fluorescence cystoscopy have shown promise to improve the ability to identify malignant bladder lesions with high sensitivity; unfortunately, they have even lower specificity than white light cystoscopy. Here, we propose to develop and evaluate a new high-resolution micro-endoscope (HRME) that can be used during white light, narrow band or fluorescence endoscopy to improve the ability to characterize bladder lesions in real time as benign or malignant with higher specificity. The HRME provides images with sub-cellular resolution, revealing morphologic detail that is normally only available from a biopsy and histology. We hypothesize that high resolution imaging of visually suspicious lesions in the bladder may improve the ability to discriminate flat, early neoplastic lesions from benign lesions, reducing the number of unnecessary biopsies performed. The goal of this proposal is to develop, optimize and validate the HRME to improve early detection of bladder cancer in high-risk patients.