Department of Urology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
J Transl Med. 2010 Nov 22;8:122. doi: 10.1186/1479-5876-8-122.
To evaluate fluorescence cystoscopy with hexaminolevulinate (HAL) in the early detection of dysplasia (DYS) and carcinoma in situ (CIS) in select high risk patients.
We selected 30 consecutive bladder cancer patients at high risk for progression. After endoscopic resection, all patients received (a) induction BCG schedule when needed, and (b) white light and fluorescence cystoscopy after 3 months. HAL at doses of 85 mg (GE Healthcare, Buckinghamshire, United Kingdom) dissolved in 50 ml of solvent to obtain an 8 mmol/L solution was instilled intravesically with a 12 Fr catheter into an empty bladder and left for 90 minutes. The solution was freshly prepared immediately before instillation. Cystoscopy was performed within 120 minutes of bladder emptying. Standard and fluorescence cystoscopy was performed using a double light system (Combilight PDD light source 5133, Wolf, Germany) which allowed an inspection under both white and blue light.
The overall incidence was 43.3% dysplasia, 23.3% CIS, and 13.3% superficial transitional cell cancer. In 21 patients, HAL cystoscopy was positive with one or more fluorescent flat lesions. Of the positive cases, there were 4 CIS, 10 DYS, 2 association of CIS and DYS, 4 well-differentiated non-infiltrating bladder cancers, and 1 chronic cystitis. In 9 patients with negative HAL results, random biopsies showed 1 CIS and 1 DYS. HAL cystoscopy showed 90.1% sensitivity and 87.5% specificity with 95.2% positive predictive value and 77.8% negative predictive value.
Photodynamic diagnosis should be considered a very important tool in the diagnosis of potentially evolving flat lesions on the bladder mucosa such as DYS and CIS. Moreover, detection of dysplasic lesions that are considered precursors of CIS may play an important role in preventing disease progression. In our opinion, HAL cystoscopy should be recommended in the early follow-up of high risk patients.
评估氨基酮戊酸光动力荧光膀胱镜检查（HAL）在选择高危患者中对异型增生（DYS）和原位癌（CIS）的早期检测作用。
我们选择了 30 例膀胱癌高危进展患者。内镜切除后，所有患者均接受（a）必要时诱导卡介苗（BCG）方案，以及（b）白光和荧光膀胱镜检查，分别在术后 3 个月进行。85mg 氨基酮戊酸（GE Healthcare，白金汉郡，英国）溶解于 50ml 溶剂中获得 8mmol/L 溶液，通过 12Fr 导管向排空的膀胱内灌注，留置 90 分钟。溶液在灌注前新鲜配制。排空膀胱后 120 分钟内行膀胱镜检查。标准和荧光膀胱镜检查使用双光源系统（Combilight PDD 光源 5133，Wolf，德国）进行，允许在白光和蓝光下进行检查。
总体异型增生发生率为 43.3%，CIS 发生率为 23.3%，浅表性移行细胞癌发生率为 13.3%。在 21 例患者中，HAL 膀胱镜检查发现 1 个或多个荧光扁平病变阳性。在阳性病例中，有 4 例 CIS，10 例 DYS，2 例 CIS 和 DYS 并存，4 例分化良好的非浸润性膀胱癌和 1 例慢性膀胱炎。在 9 例 HAL 结果阴性的患者中，随机活检显示 1 例 CIS 和 1 例 DYS。HAL 膀胱镜检查的敏感性为 90.1%，特异性为 87.5%，阳性预测值为 95.2%，阴性预测值为 77.8%。
光动力诊断应被视为一种非常重要的工具，可用于诊断膀胱黏膜上可能进展的扁平病变，如 DYS 和 CIS。此外，检测被认为是 CIS 前体的异型增生病变可能在预防疾病进展方面发挥重要作用。在我们看来，HAL 膀胱镜检查应在高危患者的早期随访中推荐使用。
