Seisen T, Rouprêt M
Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75013 Paris, France.
Prog Urol. 2013 Nov;23(14):1177-80. doi: 10.1016/j.purol.2013.06.008. Epub 2013 Jul 19.
Bladder neoplasms are the second most frequent urological cancer after prostate cancer. Bladder neoplasms arise from urothelial tissue and can either be restricted within the Mucosa and the Lamina Propria (i.e., non muscle invasive bladder cancer [NMIBC]) or invade the Muscularis Propria (i.e., muscle invasive bladder cancer [MIBC]). An exhaustive transuretral resection of the bladder tumor (TURBT) has always been seen a surrogate of quality for the initial step of the treatment. Although a large majority of bladder tumors can be easily identified macroscopically, there are flat lesions (i.e., carcinoma in situ [CIS]), which are more difficult to diagnose. To improve detection of flat lesions, a fluorescence diagnosis under blue light has been proposed during cystoscopy. Photodynamic diagnosis is performed using blue light after preoperative intravesical instillation of hexaminolaevulinic acid (Hexvix(®)) to enhance visual contrast between urothelial cancer and normal tissue. Thus, the quality of TURBT appears to be improved in selected cases with a controversial benefit on the recurrence free survival. Due to its medico-economical constraints, worldwide spread of fluorescence cystoscopy is still limited and restricted to specific cases.
膀胱肿瘤是仅次于前列腺癌的第二常见泌尿系统癌症。膀胱肿瘤起源于尿路上皮组织，可局限于黏膜和固有层（即非肌层浸润性膀胱癌[NMIBC]），也可侵犯固有肌层（即肌层浸润性膀胱癌[MIBC]）。彻底的经尿道膀胱肿瘤切除术（TURBT）一直被视为治疗初始步骤质量的替代指标。尽管大多数膀胱肿瘤在肉眼下很容易识别，但存在扁平病变（即原位癌[CIS]），更难诊断。为了提高扁平病变的检测率，有人提出在膀胱镜检查期间进行蓝光下的荧光诊断。光动力诊断是在术前膀胱内灌注六氨基乙酰丙酸（Hexvix(®)）后使用蓝光进行，以增强尿路上皮癌与正常组织之间的视觉对比度。因此，在选定的病例中，TURBT的质量似乎得到了改善，对无复发生存率有争议的益处。由于其医学经济限制，荧光膀胱镜检查在全球的普及仍然有限，仅限于特定病例。
