Reduced specificity of 5-ALA induced fluorescence in photodynamic diagnosis of transitional cell carcinoma after previous intravesical therapy

被引:87
作者
Grimbergen, MCM
van Swol, CFP
Jonges, TGN
Boon, TA
van Moorselaar, RJA
机构
[1] Univ Utrecht, Med Ctr, Dept Biomed Engn, NL-3508 GA Utrecht, Netherlands
[2] Univ Utrecht, Med Ctr, Dept Urol, NL-3508 GA Utrecht, Netherlands
[3] Univ Utrecht, Med Ctr, Dept Pathol, NL-3508 GA Utrecht, Netherlands
关键词
superficial bladder cancer; TCC of the bladder; 5-aminolevulenic acid; fluorescence diagnosis; intravesical therapy;
D O I
10.1016/S0302-2838(03)00210-0
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
Objective: Photodynamic diagnosis (PDD) for the detection of bladder cancer has become a diagnostic tool in several hospitals. Several studies have reported different rates of false positive biopsies using 5-aminolevulinic acid induced fluorescence. In this study we evaluated the effect of previous intravesical therapy on the false positive biopsy rate. Methods: Two hours prior to endoscopy 1.5 g ALA dissolved in 50 ml 1.4% NaHCO3 solution was instilled intravesically. For fluorescence excitation a blue light source (D-light, Karl Storz) was used. Under white and fluorescence light guidance, tumor locations were recorded, cold cup biopsies were taken and tumors were resected. Patients were divided into 3 groups, last intravesical therapy (IVT) less than 6 months prior to PDD, last IVT longer than 6 months before PDD and no previous IVT. Results: In total 917 biopsies were taken in 249 procedures of fluorescent and non-fluorescent areas. White light endoscopy revealed 270 and PDD 378 of in total 390 tumors, resulting in a sensitivity of 97% and specificity of 49% for PDD. Pathologic evaluation considered 270 fluorescent biopsies as false positive. The rate of false positive biopsies was 25.7% in the group No IVT, 30.6% in the group PDD-IVT >6 months, whereas in the group 'within 6 months after intravesical therapy' the rate was 39.6% (p < 0.025). When premalignant lesions such as dysplasia II are considered tumor the difference between the groups is even more significant (P < 0.001). Conclusions: The procedure has a high sensitivity for superficial bladder cancer and decreases the number of overlooked lesions. Recent intravesical therapy results in significantly more false positive fluorescent biopsies. Since patient outcome might predominantly be determined by the early detection and subsequent treatment of (pre)malignant tissue we suggest that PDD is justified even shortly after intravesical therapy. (C) 2003 Elsevier Science B.V. All rights reserved.
引用
收藏
页码:51 / 56
页数:6
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