Endomicroscopía láser confocal en el tratamiento del tumor urotelial del tracto urinario superior
2019
espanolOBJETIVOS: La endomicroscopia laser confocal (CLE) es una tecnica optica que permite la caracterizacion citologica en vivo de un tejido. Estudios previos en lesiones del tracto digestivo y respiratorio han mostrado una alta concordancia entre el resultado en vivo y el resultado histopatologico. Recientemente, se ha propuesto el uso de la CLE en el estudio del tracto urinario superior (TUS) durante la ureteroscopia, ya que permite obtener informacion a tiempo real del grado tumoral y complementa la informacion de las biopsias ureteroscopicas, que dadas sus limitaciones, pueden infraestimar el grado y el estadio de la lesion hasta en un 43% de los casos. METODOS: Se llevo a cabo una revision de la literatura en la base de datos Pubmed/Medline siguiendo las normas PRISMA. Se utilizaron 21 articulos que cumplieron los criterios de inclusion para la sintesis de la evidencia. RESULTADOS: La sensibilidad y especificidad descrita, alcanza el 79%/78% y 67%/79% para tumores de bajo y alto grado respectivamente, con una concordancia sustancial entre observadores (cirujano/anatomopatologo; K = 0,64). No se han reportado complicaciones asociadas a la utilizacion de la fluoresceina ni sondas de CLE. CONCLUSIONES: La CLE representa una herramienta util y segura, capaz de proporcionar informacion citologica de tumores del TUS en tiempo real que permite la identificacion del grado tumoral con sustancial grado de acuerdo entre la tipificacion en vivo y su analisis histopatologico final. Por este motivo, actualmente, la CLE es considerada como una herramienta en el manejo conservador del carcinoma del TUS en las guidelines de la European Association of Urology (EAU). EnglishOBJECTIVES: Confocal lasser endomicroscopy (CLE) is an optical technique that enables in vivo cytological characterization of a tissue. Previous studies have shown it useful in the evaluation of urinary and respiratory tracts for a better characterization of mucosal lesions, showing a high concordance between in vivo and final histopathological results. Recently, the use of CLE has been proposed for the study of transitional cell carcinoma of the upper urinary tract (UUT) during ureteroscopy, because it enables real time information about tumor grade and supplements the information of ureteroscopic biopsies, which may understimate the grade and stage of the lesion up to 43% of the cases due to its limitiations. METHODS: We performed a systematic review of the literature in the Pubmed/Medline database following the PRISMA standard. We selected 20 articles that complied with the inclusion criteria for evidence synthesis. RESULTS: Equipment miniaturization has enabled CLE as part of the diagnostic options in upper urinary tract tumors. This technique performs in vivo cytological characterization of the evaluated tissue, accomplishing differentiation between tumor and normal tissue, as well as tumor grade identification. Its communicated sensitivity and specificity reach 79%/78% respectively for low grade tumors and 67%/79% for high grade, with a substantial inter observer concordance (surgeon/pathologist; k=0.64). No complications have been communicated in the literature with the use of fluorescein or confocal laser microscopy probes in patients undergoing this technique. CONCLUSIONS: CLE represents a useful and safe tool, capable of providing cytological real time information of UUT tumors that enables tumor grade identification with substantial concordance between in vivo tumor typifying and the final histopathological analysis. For this, CLE is currently considered a tool for conservative management of UUT transitional cell carcinoma in the European Association of Urology (EAU) guidelines.
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