The Utility of a Flexible Fluorescence-Cystoscope with a Twin Mode Monitor for the 5-Aminolevulinic Acid-Mediated Photodynamic Diagnosis of Bladder Cancer.
The Utility of a Flexible Fluorescence-Cystoscope with a Twin Mode Monitor for the 5-Aminolevulinic Acid-Mediated Photodynamic Diagnosis of Bladder Cancer.
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DOI：
10.1371/journal.pone.0136416
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Shuin T
中科院分区：
文献类型：
--
作者：
Fukuhara H;Kureishi M;Khoda T;Inoue K;Tanaka T;Iketani K;Orita M;Inoue K;Shuin T
目的评价以5-氨基乙酰丙酸（ALA）为光动力学标记物的新型光动力学诊断系统（PDD）对膀胱肿瘤的诊断价值。为了验证在PDD中由正切效应引起的假阳性结果是否可以解决，我们比较了新的PDD系统和传统的PDD系统之间的诊断准确性。在30例经尿道膀胱活检中，15例使用刚性荧光膀胱镜（传统PDD系统）进行ALA-PDD检查，另15例使用双模式监视器（新PDD系统）进行柔性荧光膀胱镜检查。为了评价ALA-PDD的有效性，回顾性比较了传统PDD系统和新型PDD系统的诊断准确性。在30例207个标本中，我们使用传统的PDD系统获得了110个标本，使用新的PDD系统获得了97个标本。在这些样本中，我们从传统的PDD系统和新的PDD系统中各选择了30个远端膀胱标本。新的PDD系统的总体敏感性、特异性和假阳性率分别为100%、82.6%和17.4%。常规PDD系统的成功率分别为83.3%、66.2%和33.8%。与传统的PDD系统相比，新的PDD系统的整体假阳性率提高到16.4%。此外，新的PDD系统在远端膀胱样本中的假阳性率提高到11.8%。新型PDD系统的总AUC显著高于传统PDD系统（P<0.05）。在膀胱远端标本中也获得了类似的显著性结果（P<0.05）。所有患者对所有手术均耐受良好，无任何严重不良事件。与传统方法相比，软性膀胱镜检查具有显著更高的特异性和切线效应的发生率。这一初步研究表明，使用5-氨基乙酰丙酸的新的PDD系统可能比传统的PDD系统更有用。
To evaluate the diagnostic value of a new photodynamic diagnosis (PDD) system using 5-aminolevulinic acid (ALA) for the diagnosis of bladder tumors. To validate whether false-positive findings caused by tangent effects in PDD can be resolved, we compared diagnostic accuracies between the new PDD system and a conventional PDD system. Among 30 transurethral bladder biopsies, 15 cases received ALA-PDD using rigid fluorescence cystoscopy (conventional PDD system), and flexible fluorescence cystoscopy with a twin mode monitor (new PDD system) was used in a separate set of 15 cases. To evaluated the usefulness of ALA-PDD, diagnostic accuracies were retrospectively compared between the conventional PDD system and the new PDD system. Of 207 specimens from 30 cases, we obtained 110 specimens using the conventional PDD system and 97 specimens using the new PDD system. Of these samples, we selected 30 distal bladder specimens each from both the conventional PDD system and the new PDD system. The overall sensitivity, specificity and false-positive rate for the new PDD system were 100%, 82.6%, and 17.4%, respectively. Those of the conventional PDD system were 83.3%, 66.2% and 33.8%, respectively. The overall false-positive rate of the new PDD system improved to 16.4% when compared with the conventional PDD system. Furthermore, the false-positive rate of the new PDD system in distal bladder samples improved to 11.8%. The overall AUC of the new PDD system was significantly greater compared with that of the conventional PDD system (P<0.05). We obtained similar significant results in the distal bladder samples (P<0.05). All procedures were well tolerated by all patients without any severe adverse events. Flexible cystoscopy had a significantly higher specificity and improved incidence of tangent effects when compared with conventional methods. This preliminary study suggests that the new PDD system using 5-aminolevulinic acid may be more useful than the conventional PDD system.