Ray Eleanor R, Chatterton Kathryn, Khan Mohammed S, Thomas Kay, Chandra Ashish, O'Brien Tim S
Departments of Urology and Histopathology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
BJU Int. 2009 May;103(10):1363-7. doi: 10.1111/j.1464-410X.2008.08238.x. Epub 2008 Dec 8.
To investigate the value of photodynamic diagnosis (PDD) using hexylaminolaevulinate (Hexvix, PhotoCure, Oslo, Norway) in the investigation of patients with positive urine cytology who have no evidence of disease after standard initial investigations.
Twenty-three patients referred with positive urine cytology but no current histological evidence of cancer were investigated between April 2005 and January 2007 with PDD, using Hexvix and the D-light system (Karl Storz, Tuttlingen, Germany) to detect fluorescence. The bladder was mapped initially under white light and then under 'blue-light'. Biopsies were taken from abnormal urothelium detected by white light, fluorescence, or both. All cytological specimens were reviewed by a reference cytopathologist unaware of the result of the PDD.
Twenty-five PDD-assisted cystoscopies were carried out on 23 patients (20 men/3 women; median age 64 years, range 24-80 years). Of the 23 patients, 17 (74%) were previously untreated for transitional cell carcinoma (TCC), whilst six were under surveillance for previous TCC. Nineteen of the 23 (83%) cytology specimens were confirmed as suspicious or positive by the reference pathologist. TCC of the bladder or preneoplastic lesions were diagnosed in six patients, i.e. six (26%) of those investigated and six of 19 (32%) with confirmed positive cytology. Four of the six were under surveillance for previous bladder tumour. Additional pathology was detected by fluorescence in five of the six patients, including two carcinoma in situ (CIS), one CIS + G3pT1 tumour, and two dysplasia. Diagnoses in PDD-negative cases included one upper tract TCC and four patients with stones. In addition, one patient had CIS diagnosed on both white light and PDD 6 months later.
Additional pathology was detected by HAL fluorescence cystoscopy in 32% of patients with confirmed positive urinary cytology. PDD is a key step in the management of patients with positive urinary cytology and no evidence of disease on conventional tests.
探讨使用六氨基乙酰丙酸（Hexvix，挪威奥斯陆PhotoCure公司）进行光动力诊断（PDD）在初诊检查无疾病证据但尿细胞学检查呈阳性的患者中的应用价值。
2005年4月至2007年1月期间，对23例尿细胞学检查呈阳性但目前无癌症组织学证据的患者使用Hexvix和D-light系统（德国图特林根卡尔·史托斯公司）进行PDD检查，以检测荧光。首先在白光下对膀胱进行定位，然后在“蓝光”下进行定位。从白光、荧光或两者检测到的异常尿路上皮处取活检组织。所有细胞学标本均由一位不知PDD结果的参考细胞病理学家复查。
对23例患者（20例男性/3例女性；中位年龄64岁，范围24 - 80岁）进行了25次PDD辅助膀胱镜检查。23例患者中，17例（74%）既往未接受过移行细胞癌（TCC）治疗，6例正在接受既往TCC的监测。23例中的1十九例（83%）细胞学标本经参考病理学家确认为可疑或阳性。6例患者被诊断为膀胱TCC或癌前病变，即受检患者中的6例（26%）以及19例确诊细胞学阳性患者中的6例（32%）。6例中有4例正在接受既往膀胱肿瘤的监测。6例患者中有5例通过荧光检测到额外病变，包括2例原位癌（CIS）、1例CIS + G3pT1肿瘤和2例发育异常。PDD阴性病例的诊断包括1例上尿路TCC和4例结石患者。此外，1例患者在白光检查时及6个月后的PDD检查中均被诊断为CIS。
在确诊尿细胞学阳性的患者中，32%通过HAL荧光膀胱镜检查发现了额外病变。PDD是尿细胞学阳性且传统检查无疾病证据患者管理中的关键步骤。
