Diagnostic efficacy of fluorescence cystoscopy for detection of urothelialneoplasms

Background and Purpose: A major problem diagnosing bladder cancer using con ventional white-light cystoscopy is that flat and tiny papillary neoplasms can be overlooked. Fluorescence cystoscopy is based on the detection of pro toporphyrin IX (PpIX)-induced fluorescence in urothelial neoplasms through the topical administration of 5-aminolevulinic acid (ALA). The diagnostic e fficacy of fluorescence cystoscopy in urothelial neoplasms was evaluated in this study. The focus of this investigation was to ascertain whether fluor escence cystoscopy could make a major contribution to staging and improving the choice of adjuvant therapy after transurethral resection. Patients and Methods: A series of 62 patients with suspected bladder cancer were investigated by fluorescence cystoscopy. An intravesical instillation of ALA was conducted 2 hours prior to fluorescence. A total of 274 tissue samples were obtained from the fluorescing and nonfluorescing areas of the bladder. Results: The sensitivity and negative predictive value of fluorescence cyst oscopy were 98.0% and 94.7%, respectively, but the specificity was low (42. 9%). Among a total of 148 lesions of urothelial neoplasm, 58 foci (dysplasi a in 5, carcinoma in situ in 19, stage T-a in 15, T-1 in 15, above T-2 in 4 ) that were invisible under white-light cystoscopy were detected by fluores cence cystoscopy. The final histopathologic status was changed in 45% of pa tients (28/62) according to this technique. Among these patients, eight (13 %) needed additional therapy, including a radical cystectomy in one patient and intravesical therapy in 10. Conclusions: The ALA-based fluorescence cystoscopy technique is a safe and simple procedure that enhances the detection of flat and papillary urotheli al neoplasms. Moreover, it will be able to provide useful information that will enable proper staging and appropriate further treatment.