Bladder cancer diagnosis in a new light

Bladder cancer is the most common malignancy of the urinary tract in both man and women. Histological staging and grading are important factors determining prognosis and treatment management of bladder cancer. The general goal of this thesis is to improve bladder cancer diagnosis and management using optical imaging techniques. The first part of this thesis focuses on the evaluation of confocal laser endomicroscopy (CLE) for bladder cancer diagnosis. CLE is a high-resolution imaging technique that has the ability to visualise tissue on a microscopic level in vivo. Therefore, CLE could overcome the shortcoming of the lack of histologic assessment of bladder tissue during cystoscopy. The results presented in this thesis show promising results for CLE imaging of bladder tissue. It is a safe procedure to obtain in vivo imaging of bladder tumours, and by identifying CLE features of urothelial carcinoma it is possible to diagnose and grade bladder cancer. The second part of this thesis focuses on the use of fluorescence in situ hybridization (FISH) to identify patients with a higher risk for developing bladder tumour recurrence following Bacillus Calmette-Guérin (BCG) therapy. The results in this thesis suggest that patients who have a positive FISH test 3 months following initial transurethral resection of the bladder tumour have a higher risk for developing tumour recurrence. By using FISH it is possible to identify patients that are more likely to develop a recurrence in time at an earlier stage and before clinical signs are present. FISH could therefore assist urologists in risk stratification and counselling patients that have a higher risk for developing tumour recurrence after BCG therapy. Both CLE and FISH may contribute to tailor bladder cancer management. By enabling earlier diagnosis and improved risk assessment, treatment and management of bladder cancer can be individually tailored to optimise the best response and least burden for patients.