Oral 5-aminolevulinic acid in simultaneous photodynamic diagnosis of upper and lower urinary tract transitional cell carcinoma - a prospective audit
Oral 5-aminolevulinic acid in simultaneous photodynamic diagnosis of upper and lower urinary tract transitional cell carcinoma - a prospective audit
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DOI：
10.1111/j.1464-410x.2012.11326.x
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发表时间：
2012-12-01
影响因子：
4.5
通讯作者：
Kata, Slawomir Grzegorz
中科院分区：
文献类型：
--
作者：
Ahmad, Sarfraz;Aboumarzouk, Omar;Kata, Slawomir Grzegorz
目的评价口服5-氨基乙酰丙酸（5-ALA）后光动力诊断输尿管肾镜检查对上尿路尿路上皮癌的诊断准确性。26例患者接受了39例手术在口服给予5-ALA用于光动力学诊断（PDD）后，对膀胱镜检查/输尿管肾镜检查进行了检查。在计划的内镜检查前4小时，在标准白色光膀胱镜和输尿管肾镜检查后，使用D-light系统进行光动力学诊断内镜检查（Olympus PDD膀胱镜和7.5Fr KARL STORZ PDD Flex-X输尿管肾镜）检测荧光。记录病变是否在白色或蓝光或两者下检测到。对可疑的尿路上皮病变进行了总共62次活检（35例膀胱，26例输尿管/肾盂和1例前列腺尿道）。在35例膀胱活检中，在白色和蓝光下共观察到11个病灶，其中91%为恶性，24个病灶为非恶性（68.5%）活检标本取自仅在蓝光下可见的病变，其中45.8%为恶性。同样，在26例输尿管/肾盂盏活检标本中，白色光和蓝光同时照射11例，恶性肿瘤100%，蓝光照射10例，白光照射10例，蓝光照射10例（38.5%）的病变仅在蓝光下可见，其中70%为恶性病变。ALA安全可行，具有检测传统白色光内窥镜无法观察到的病变的额外优势。这可能会转化为更完整的治疗，从而减少上尿路尿路上皮癌的后续复发和可能的进展。
OBJECTIVETo evaluate the diagnostic accuracy of photodynamic diagnostic ureterorenoscopy after oral administration of 5-aminolevulinic acid (5-ALA) for upper urinary tract urothelial cancers.PATIENTS AND METHODSIn this audit, twenty-six patients underwent thirty-nine procedures (cystoscopy/ureterorenoscopy) following oral administration of 5-ALA for photodynamic diagnosis (PDD).Twenty mg/kg body weight of 5-ALA was given orally 3-4 hours prior to the planned endoscopic visualisation.Following standard white light cystoscopy and ureterorenoscopy, photodynamic diagnostic endoscopy was performed using D-light system (Olympus PDD cystoscope and 7.5Fr KARL STORZ PDD Flex-X ureterorenoscope) to detect fluorescence.Biopsies were carried out from all suspicious areas, noting if lesions were detected under white or blue light or both.RESULTSA total of sixty-two biopsies were performed for suspicious urothelial lesions (35 bladder, 26 ureter/renal pelvis and 1 from prostatic urethra).Of the 35 bladder biopsies, 11 lesions were seen under both white and blue light and 91% of these were malignant.While 24 (68.5%) biopsies were taken from lesions seen only under blue light and 45.8% of these were malignant.Similarly, of the 26 ureteric/renal pelvicalyceal biopsies, 11 were concurrent in both white and blue light and 100% of these were malignant.While 10 (38.5%) lesions were seen only under blue light and 70% of these were malignant.CONCLUSIONSPhotodynamic diagnosis using oral 5-ALA is safe and feasible with additional advantages of detecting lesions not visualised with conventional white light endoscopy.This may translate into more complete treatment thereby decreasing subsequent recurrences and possibly progression of the upper urinary tract urothelial cancers.