Purpose of review: Recent advances in imaging techniques provide innovative tools for the detection of bladder cancer. In patients with nonmuscle invasive cancer, there is a need for enhanced visualization of flat growing lesions and multifocal tumors. The aim of new imaging modalities is the improved detection and staging of bladder lesions, as an adjunct to conventional white light endoscopy.
Recent findings: Fluorescence cystoscopy with 5-aminolevulinic acid and hexaminolevulinate has been shown to improve the detection of papillary and flat bladder lesions in comparison to conventional white light cystoscopy. Prospective phase III clinical trials have demonstrated advanced diagnostic ability, enhanced tumor resection, and reduced tumor recurrence. Molecular targets for photodynamic diagnosis are currently under investigation. Narrow band imaging has gained in popularity because of its availability in both flexible and rigid cystoscopy and ureteroscopy and its potential for detection of carcinoma in situ. Emerging endomicroscopic technologies such as optical coherence tomography, confocal laser endomicroscopy, and Raman spectroscopy introduce real-time histologic imaging during the procedure.
Summary: While scientific evidence supports macroscopic applications, such as photodynamic diagnosis or narrow band imaging, and their progressive implementation in the clinical workflow, further studies are needed to identify the adjunct endomicroscopic technology optimal for enhanced accuracy and utility.