Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy
Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy
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DOI：
10.1097/01.ju.0000100480.70769.0e
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发表时间：
2004-01-01
影响因子：
6.6
通讯作者：
Marberger, M
中科院分区：
文献类型：
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作者：
Schmidbauer, J;Witjes, F;Marberger, M
目的：在这个欧洲的多中心研究中，我们比较了六氨基酮戊酸（HAL）荧光膀胱镜检查和标准的白色光膀胱镜检查原位癌（CIS）的患者怀疑有高风险的膀胱cancer.Materials和Methods：这项研究是一个前瞻性对照，患者内比较标准和HAL荧光膀胱镜检查。合格患者接受膀胱内滴注50 ml HAL 8 mM溶液。使用D光系统进行膀胱镜检查，该系统提供375至440 nm的白色和蓝色光。首先在白色光下，然后在蓝光下检查和标测膀胱壁。在白色光和红色荧光下识别的所有肿瘤和可疑区域均被切除或活检。组织学检查结果由一名独立的中心病理学家进行评估，该病理学家对活检的身份不知情。在211例可评估患者中，83例（39%）患有CIS，其中18例（22%）仅通过HAL膀胱镜检查发现，62例（75%）通过标准和HAL膀胱镜检查发现，2例（2%）仅通过标准膀胱镜检查检出，1例（1%）通过非引导活检检出。因此，HAL膀胱镜检查比标准膀胱镜检查多识别28%的CIS患者。HAL滴注的副作用可以忽略不计，没有意外事件reported.Conclusions：HAL荧光膀胱镜提高了膀胱CIS的检测显着，这对临床管理的后果，并可能改善患者的预后。该程序很容易实现作为一个辅助标准膀胱镜检查，它没有增加显着的并发症的风险。
Purpose: In this European multicenter study we compared hexaminolevulinate (HAL) fluorescence cystoscopy and standard white light cystoscopy for the detection of carcinoma in situ (CIS) in patients suspected of having high risk bladder cancer.Materials and Methods: This study was a prospective controlled, within-patient comparison of standard and HAL fluorescence cystoscopy. Eligible patients received an intravesical instillation of 50 ml HAL 8 mM solution. Cystoscopy was performed using a D light system, which provided white and blue light at 375 to 440 nm. The bladder wall was inspected and mapped, first under white light, followed by blue light. All tumors and suspicious areas identified under white light and by red fluorescence were resected or biopsied. Histological findings were assessed by an independent central pathologist blinded to the identity of the biopsies.Results: Of 211 evaluable patients 83 (39%) had CIS, of whom 18 (22%) were detected by HAL cystoscopy only, 62 (75%) were detected by standard and HAL cystoscopy, 2 (2%) were detected by standard cystoscopy only and 1 (1%) was detected by nonguided biopsy. Therefore, HAL cystoscopy identified 28% more patients with CIS than standard cystoscopy. The side effects of HAL instillation were negligible and no unexpected events were reported.Conclusions: HAL fluorescence cystoscopy improves the detection of bladder CIS significantly, which has consequences for clinical management and may improve the patient prognosis. The procedure is easily implemented as an adjunct to standard cystoscopy and it adds no significant risk of complications.