FLUORESCENCE DETECTION OF FLAT TRANSITIONAL-CELL CARCINOMA AFTER INTRAVESICAL INSTILLATION OF AMINOLEVULINIC ACID

Carcinoma in situ (CIS) of the bladder is a confounding disease that i s difficult to recognize endoscopically because it is a flat cancer. M any studies have suggested its relationship with subsequent invasive d isease. Early recognition of CIS therefore is essential in offering th e patient the most appropriate treatment and the highest cure rate. Be cause white light cystoscopic examination is not sufficient to reveal areas of dysplasia or CIS, random biopsies are recommended. The author s evaluate whether amino levulinic acid (ALA) fluorescence detection c ould be helpful in diagnosing CIS and if the specificity could be enha nced by reducing the ALA dose. Sixteen patients with papillary bladder cancer, and CIS and dysplasia were given low-dose ALA. Fluorescence d etection of the metabolized ALA was performed 3 hours later, with the naked eye, after blue light illumination. Carcinoma in situ or dysplas ia was found in 50 biopsies. The sensitivity for detecting CIS was 94% with a specificity of 54%. Carcinoma in situ can be diagnosed with a very high accuracy through fluorescence detection after ALA instillati on. Fluorescence detection can be achieved with the naked eye and does not necessitate either complex equipment or specially trained personn el.