Clinical results of the transurethral resection and evaluation of superficial bladder carcinomas by means of fluorescence diagnosis after intravesical instillation of 5-aminolevulinic acid
Clinical results of the transurethral resection and evaluation of superficial bladder carcinomas by means of fluorescence diagnosis after intravesical instillation of 5-aminolevulinic acid
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DOI：
10.1089/end.1999.13.117
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发表时间：
1999-03-01
影响因子：
2.7
通讯作者：
Wieland, WF
中科院分区：
文献类型：
--
作者：
Filbeck, T;Roessler, W;Wieland, WF
背景与目的：浅表性膀胱癌的高复发率需要新的诊断和治疗方法。特别是，在检测方面的改进是必要的，可以更好地切除在白光下很差或无法检测到的扁平病变。在一项前瞻性研究中，研究了荧光诊断在膀胱癌检测和经尿道切除中的有效性。材料与方法：采用5-氨基乙酰丙酸荧光法对120例患者行347例活检或肿瘤切除，124例检出尿路上皮癌及发育不良。结果：荧光阳性119例（N = 74 pTaG1/2; N = 9 pT1G1/2; N = 11 pT1G3; N = 7原位癌；N = 6 > T1; N = 12 II型非典型增生），假阴性5例（N = 3 pTaG1/2; N = 1 pT1G1/2; N = 1 II型非典型增生）。荧光诊断的敏感性（96.0%）显著高于白光膀胱镜检查的敏感性（67.5%）（P < 0.0001）。分别对原发或复发肿瘤切除和二次肿瘤切除的数据，其敏感性分别为100%和80%，显著高于白光膀胱镜检查的80.8%和20% （P < 0.0001和P < 0.0008）。荧光诊断在二次经尿道切除术中的敏感性较低，这是由于以前切除区域的假阴性发生率较高。结论：高假阳性率限制了荧光结果的正确解释。尽管如此，荧光诊断在任何情况下都优于白光膀胱镜检查。通过更好的检测尿路上皮肿瘤和发育不良，在荧光控制下更彻底、更广泛的切除，应该有可能降低浅表性膀胱癌的复发率。
Background and Objective: The high recurrence rate of superficial bladder carcinomas requires new approaches in diagnosis and therapy. Particularly, an improvement in detection, resulting in better resection of flat lesions, which are poorly or not detectable under white light, is necessary. The effectiveness of fluorescence diagnosis for detection and transurethral resection of bladder carcinomas was investigated in a prospective study.Materials and Methods: From 120 patients, 347 biopsies were taken or tumors resected with the aid of fluorescence from 5-aminolevulinic acid, Urothelial carcinomas and dysplasias were detected in 124 cases.Results: Of the lesions, 119 were fluorescence positive (N = 74 pTaG1/2; N = 9 pT1G1/2; N = 11 pT1G3; N = 7 carcinoma in situ; N = 6 p > T1; N = 12 dysplasia II), and 5 were falsely negative (N = 3 pTaG1/2; N = 1 pT1G1/2; N = 1 dysplasia II). The sensitivity of the fluorescence diagnosis (96.0%) was significantly higher than the 67.5% sensitivity of white-light cystoscopy (P < 0.0001). Taking the data for primary or recurrent tumor resection and secondary resection separately, the sensitivity was 100% and 80%, respectively, and was significantly higher than that of white-light cystoscopy, which was 80.8% and 20%, respectively (P < 0.0001 and P < 0.0008). The lower sensitivity of fluorescence diagnosis in secondary transurethral resection is attributed to the higher rate of false-negative findings in areas of former resection.Conclusions: The high rate of false-positive findings limits the correct interpretation of fluorescence findings. In spite of this, fluorescence diagnosis is superior to white-light cystoscopy in every case. By means of better detection of urothelial neoplasias and dysplasias, as well as more thorough and extensive resection under fluorescence control, it should be possible to reduce the recurrence rate of superficial bladder carcinomas.