Elsevier

Urology

Volume 60, Issue 6, December 2002, Pages 1025-1028
Urology

Adult urology
Do patients profit from 5-aminolevulinic acid-induced fluorescence diagnosis in transurethral resection of bladder carcinoma?

https://doi.org/10.1016/S0090-4295(02)01961-1Get rights and content

Abstract

Objectives

To evaluate in a prospective study the influence of fluorescence diagnosis (FD) controlled transurethral resection of bladder tumors on therapeutic consequences. The aim was to determine in how many patients FD led to a change in treatment strategy compared with conventional white light (WL) cystoscopy.

Methods

A total of 279 patients with suspected bladder tumors underwent transurethral resection using FD in addition to WL cystoscopy. The number of additional tumor-positive patients, staging change, number of multilocular tumors exclusively detected by FD, and resulting therapeutic consequences compared with the results after WL cystoscopy were investigated. In addition a biopsy-based evaluation was performed.

Results

Tumor or dysplasia II° (moderate dysplasia) was detected in 177 patients. In 168 patients, tumor was detected by WL cystoscopy, and in 9 (5.1%) of the patients, tumor was completely overlooked by WL cystoscopy and diagnosed exclusively by FD (n = 3 TaG1-G2, n = 2 carcinoma in situ, n = 1 greater than T1, and n = 3 dysplasia II°). Multilocular tumor involvement was detected in 10 cases using FD, and a change in the stage by detection of coexisting dysplasia II° and carcinoma in situ occurred in 8 patients. In 27 patients (15.3%), additional information was obtained by exclusive detection of tumors by FD. This resulted in a change in the treatment strategy for 16 patients (9%).

Conclusions

FD leads to an improvement in the diagnosis of bladder carcinoma. It allows the early selection of the best treatment option and thus has a potentially positive effect on the prognosis of the affected patients.

Section snippets

Material and methods

The study was designed as a within-patient evaluation to determine the additional number of patients in whom FD-controlled TUR led to therapeutic consequences. From January 1997 to December 2000, 279 patients (age range 34 to 89 years) with suspected primary or recurrent bladder tumor underwent TUR with FD at our institution.

Two hours before the planned TUR, all the patients were catheterized and 50 mL of a 3% 5-ALA solution (1.5 g ALA dry substance in 50 mL 5.4% sodium hydrogen carbonate

Results

Tumor or DII was detected in 177 of 279 patients with suspected primary or recurrent tumor. A total of 636 biopsies were taken or tumors resected. Of 336 tumors, 50 (14.9%) were overlooked with WL and were only diagnosed by FD. The difference in the detection of flat urothelial lesions, CIS, and DII was particularly striking in the biopsy-based evaluation (Table I). Thus, 17 (57%) of cases of CIS and 7 (44%) of 16 cases of DII were diagnosed by FD, which is equivalent to an additional

Comment

FD is characterized primarily by the possibility of diagnosing tumors that are difficult or impossible to visualize conventionally, thereby increasing the detection rate of individual tumors. In particular, flat lesions with high malignant potential such as CIS can be diagnosed markedly better and more often, as shown by the additional detection rate with FD of 57% in this study. Different investigators have confirmed this observation and have reported a markedly higher rate of detection of

Conclusions

FD leads to an improvement in the diagnosis in bladder carcinoma. Therefore, establishing this method as a standard procedure in the diagnosis and treatment of bladder tumors should be discussed. Multicenter clinical trials are necessary and have been ongoing for several years and will possibly strengthen our findings.

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