Hexyl aminolevulinate fluorescence cystoscopy:: A new diagnostic tool for the photodiagnosis of superficial bladder cancer -: A multicenter study

被引:213
作者
Jichlinski, P
Guillou, L
Karlsen, SJ
Malmström, PU
Jocham, D
Brennhovd, B
Johansson, E
Gärtner, T
Lange, N
van den Bergh, H
Leisinger, HJ
机构
[1] CHUV Univ Hosp, Dept Urol, Lausanne, Switzerland
[2] CHUV Univ Hosp, Inst Pathol, Lausanne, Switzerland
[3] EPFL, Swiss Fed Inst Technol, Inst Environm Engn, CH-1015 Lausanne, Switzerland
[4] Aker Univ Hosp, Oslo Urol Univ Clin, Oslo, Norway
[5] Univ Uppsala Hosp, Dept Urol, S-75185 Uppsala, Sweden
[6] Univ Hosp Lubeck, Dept Urol, Lubeck, Germany
关键词
bladder; bladder neoplasms; fluorescence; cystoscopy; carcinoma in situ;
D O I
10.1097/01.ju.0000060782.52358.04
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We examined the sensitivity and specificity of Hexvix (PhotoCure ASA, Oslo, Norway) hexyl aminolevulinate (HAL) fluorescence cystoscopy in patients with superficial bladder cancer. Materials and Methods: A total of 52 patients (38 men and 14 women) with a mean age of 72 years were investigated. HAL hydrochloride (100 mg dissolved in 50 ml phosphate buffer solution) (8 mM) was instilled into the bladder 1 hour prior to the endoscopic procedure. Cystoscopy was performed with the Storz D-light (Karl Storz, Tuttlingen, Germany) system, allowing inspection of the bladder wall under white and blue light (380 to 450 nm). Results: A total of 422 biopsies obtained in fluorescing (165) and nonfluorescing (257) areas, including 5 random biopsies per patient, were analyzed to provide the best reference for the calculation of sensitivity and specificity. There were a total of 143 histologically verified tumors in 45 patients, including carcinoma in situ (CIS), Ta or T1 lesions. A total of 43 patients were diagnosed by fluorescence cystoscopy compared with 33 diagnosed by white light for 96% and 73% per-patient sensitivity, respectively. HAL cystoscopy was found particularly useful for finding CIS tumors. Of 13 patients with CIS tumors all except 1 were diagnosed or confirmed by HAL cystoscopy. HAL cystoscopy was well tolerated with no definite drug related adverse events reported, including effects on standard blood parameters. Conclusions: HAL fluorescence cystoscopy is a new, sensitive, promising diagnostic procedure that showed improved detection of bladder tumors, in particular CIS. The procedure is well tolerated and can easily be implemented in current clinical practice.
引用
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页码:226 / 229
页数:4
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