Fluorescence detection of flat bladder carcinoma in situ after intravesical instillation of hypericin

Purpose: We determined the sensitivity and specificity of detecting flat bl adder carcinoma in situ through fluorescent detection after intravesical hy pericin instillations. Materials and Methods: The study included 40 patients, of whom 26 presented with macroscopic visible tumor, 9 had a positive cytology without visible tumor and 5 underwent cystoscopy after bacillus Calmette-Guerin instillatio ns (4) or radiotherapy (1). We instilled 40 mi. of a 8 mu M. solution of hy pericin intravesically for at least 2 hours. Fluorescence excitation with b lue light was effective up to 16 hours after termination of the instillatio n. Results: All visible papillary tumors showed red fluorescence. In addition, 134 flat fluorescent areas were detected. Analysis of 281 biopsies from fl at bladder wall indicated 93% sensitivity and 98.5% specificity for detecti ng carcinoma in situ. Visible lesions resulting from radiotherapy, chemothe rapy or immunotherapy did not show any fluorescent signs and, therefore, di d not induce false-positive readings. There were no signs of photobleaching during inspection and resection. Conclusions: We report a simple yet comprehensive endoscopic method for ear ly detection of bladder cancer, including carcinoma in situ. Hypericin indu ced fluorescence has a high sensitivity and specificity for detection of bl adder transitional cell carcinoma, papillary and flat carcinoma in situ. Wh en carcinoma in situ is suspected, this technique is highly recommended.