Elsevier

Urology

Volume 69, Issue 2, February 2007, Pages 260-264
Urology

Adult urology
Seven Years’ Experience with 5-Aminolevulinic Acid in Detection of Transitional Cell Carcinoma of the Bladder

https://doi.org/10.1016/j.urology.2006.10.015Get rights and content

Objectives

Photodynamic diagnosis (PDD) using 5-aminolevulinic acid has proved to be a procedure with an outstanding sensitivity for the detection of transitional cell carcinoma of the bladder, in particular in the detection of flat urothelial lesions. We report on our clinical results with 875 patients (1713 PDD procedures) between March 1995 and March 2002.

Methods

A total of 1713 PDD procedures were done in 875 patients. Fluorescence imaging was performed 2 to 3 hours after instillation of 50 mL of a 3% solution of 5-aminolevulinic acid into the bladder by an incoherent light source. In total, specimens from 4630 lesions (2.7 lesions/PDD) were taken.

Results

In 34.8% of all biopsies, the histologic finding was malignant; 23.7% of these biopsies had been taken only because of positive fluorescence. In 28.5% of the positive biopsies, flat lesions had been identified. Also, 43.4% of carcinoma in situ and 30.7% of dysplasia II° were detected only by positive fluorescence. Of all tumor lesions, 92.0% were detected by PDD compared with 76.3% detected by white light endoscopy.

Conclusions

PDD has proved to be an effective detection device for superficial bladder cancer.

Section snippets

Patients

From February 1995 to February 2002, 1713 PDD procedures were performed in 875 patients (204 women and 671 men, age range 16 to 99 years, average age 65.3). Of the 875 patients, 327 were treated for primary bladder cancer and 548 were under surveillance because of previous transitional cell carcinoma of the urinary bladder. The patients with a history of recurrent disease had undergone multiple TURs (range 1 to 22, average 3.6). All patients provided written informed consent.

5-ALA Administration

We instilled 1.5 g

Results

In total, 1713 fluorescence endoscopy procedures were performed in 875 patients. Biopsies from 4630 lesions were obtained. The mean biopsy rate was 2.7 per endoscopy. Papillary tumors, as well as flat urothelial lesions, developed a bright red fluorescence. In contrast, the adjacent normal urothelium appeared blue. For 139 fluorescence endoscopy procedures, the WLE and fluorescence findings were negative.

No patients had any side effects from intravesical application of 5-ALA; in particular, no

Comment

The current diagnostic and therapeutic approaches for bladder cancer seem to be inadequate in many respects.4, 8 The present data, which to our knowledge contain the greatest number of fluorescence endoscopic procedures published to date, support the finding that PDD is highly effective in the identification of transitional cell carcinoma of the bladder compared with WLE alone. Previously, various studies performed by different investigators demonstrated the diagnostic value of PDD, with a

Conclusions

Seven years after the introduction of 5-ALA-induced fluorescence endoscopy in the detection of bladder cancer, PDD has become an established procedure in daily routine use. The detection rate for all tumor lesions, and in particular for flat lesions, has been markedly improved compared with WLE. Furthermore, recent data have shown a significant reduction in residual tumor after TUR, and PDD has been proved to reduce the recurrence rate in patients with transitional cell carcinoma of the

References (30)

  • M. Kriegmair et al.

    Transurethral resection for bladder cancer using 5-aminolevulinic acid induced fluorescence endoscopy versus white light endoscopy

    J Urol

    (2002)
  • G. Jakse et al.

    A second-look TUR in T1 transitional cell carcinoma: why?

    Eur Urol

    (2004)
  • T. Filbeck et al.

    Clinically relevant improvement of recurrence-free survival with 5-aminolevulinic acid induced fluorescence diagnosis in patients with superficial bladder tumors

    J Urol

    (2002)
  • D. Zaak et al.

    Role of 5-aminolevulinic acid in the detection of urothelial premalignant lesions

    Cancer

    (2002)
  • S. Bastacky et al.

    The accuracy of urinary cytology in daily practice

    Cancer

    (1999)
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    This study was supported by grants from the Deutsche Forschungsgemeinschaft (DFG Kr1645/1-1).

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