Adult urologyDo patients profit from 5-aminolevulinic acid-induced fluorescence diagnosis in transurethral resection of bladder carcinoma?
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.
References (15)
- et al.
Role of 5-aminolevulinic acid in the diagnosis and treatment of superficial bladder cancerimprovement in diagnostic sensitivity
Urology
(2001) - et al.
Endoscopic detection of transitional cell carcinoma with 5-aminolevulinic acidresults of 1012 fluorescence endoscopies
Urology
(2001) - et al.
Fluorescence photodetection of neoplastic urothelial lesions following intravesical instillation of 5-aminolevulinic acid
Urology
(1994) - et al.
Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rate in superficial bladder cancer
J Urol
(2001) - et al.
Clinical results of the transurethral resection and evaluation of superficial bladder carcinomas by means of FD after intravesical instillation of 5-aminolevulinic acid
J Endourol
(1999) - et al.
Detection of early bladder cancer by 5 aminolevulinic acid induced porphyrin fluorescence
J Urol
(1996) - et al.
Clinical evaluation of a method for detecting superficial surgical transitional cell carcinoma of the bladder by light induced fluorescence of protoporphyrin IX following the topical application of 5-aminolevulinic acidpreliminary results
Lasers Surg Med
(1997)