OCT - Cure for Cancer Gala

MP32-12
Percutaneous Needle Based
Optical Coherence Tomography for the
Differentiation of Renal Masses
M Buijs, PGK Wagstaff, DM de Bruin, PJ Zondervan, CDH Savci, OM van Delden, TG van Leeuwen, RJA
van Moorselaar, JJMCH de la Rosette, MP Laguna Pes
Background
OCT
Goal
• Increased incidence of Small Renal Masses
• Optical equivalent of ultrasound
Assess the diagnostic accuracy of OCT in the
(SRMs)
• High resolution images are created within
diagnosis of kidney cancer
• Renal biopsies high non-diagnostic rate,
seconds
• Primary: Defining µOCT values corresponding
up to 20% in cT1A tumors
• Image resolution ~ 10 µm, max image depth 2- with benign and malignant renal masses
• 17-40% of resected renal tumours are
3mm
• Secondary: Defining µOCT values corresponding
benign on surgical pathology
• Loss of light intensity per millimeter of tissue
with the three main subtypes of renal cell
• Imbalance diagnosis and treatment paradigm
penetration expressed as the attenuation
carcinoma (RCC)
coefficient (µOCT) in mm-1
Real time biopsy can reduce the amount of non-diagnostics and achieve tailored treatment on a patient level
Methods
Population: 86 patients, ≥ 18 years, solid enhancing renal mass and candidate for
active treatment
Intervention: Renal mass puncture consisting of percutaneous needle based OCT
during standard core biopsies
Analysis of OCT data: Performed by researcher blinded for pathology.
Correlation between µOCT values and PA results of surgical specimen
Results
median µOCT of RCC at 4.2mm-1, P=0.0020
• Optimal µOCT cut-off value of >3.2
-1
mm :
sensitivity, specificity,
PPV and NPV of 91%, 67%, 96% and 46%, for differentiation
between oncocytoma and RCC
• Area under the curve (AUC) = 0.80 (95% CI 0.66–0.92)
• Subtype analysis: significance for oncocytoma vs ccRCC
(3.2mm-1 vs. 4.2 mm-1; P=0.0020) and oncocytoma vs pRCC
Attenuation coefficient µOCT (mm-1)
Median µOCT of oncocytoma 3.2 mm-1 significantly lower than
Figure 1. A) Boxplot of oncocytoma (n=9) vs. RCC (n=77). B) ROC curve of oncocytoma (n=9)
vs. RCC (n=77).
(3.2 mm-1 vs. 4.2 mm-1; P=0.0156).
Figure 2: Onocytoma in OCT vs pathology
Figure 3: clear cell RCC in OCT vs pathology
Conclusions
• OCT is able to quantitatively differentiate between benign and malignant tumours
• µOCT significantly lower in oncocytoma vs RCC
• Diagnostic accuracy demonstrated through AUC of 80%, yielding sensitivity, specificity, PPV and NPV of 91%,
67%, 96% and 46%
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