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

• Published in: Urology (Ridgewood, N.J.) Vol. 60; no. 6; pp. 1025 - 1028
• Main Authors: Filbeck, T, Pichlmeier, U, Knuechel, R, Wieland, W.F, Roessler, W
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2002; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Aminolevulinic Acid; Biological and medical sciences; Biopsy; Carcinoma in Situ - diagnosis; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Fluorescence; Humans; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Photosensitizing Agents; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Urinary Bladder - pathology; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Human; Urinary system disease; Carcinoma; Resection; Exploration; Malignant tumor; Urinary tract disease; Treatment; Urinary bladder; Surgery; Bladder disease; Technique; Immunofluorescence
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(02)01961-1

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. 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. 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%). 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.