Charbit D, Arnoux V, Gobet F, Pasquier D, Descotes J-L, Pfister C
Service d'urologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
Service d'urologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France.
Prog Urol. 2014 Jul;24(9):551-5. doi: 10.1016/j.purol.2014.01.001. Epub 2014 Feb 14.
The objective of this retrospective study was to assess the usefulness of fluorescence during cystoscopy after BCG-therapy in the management of non-invasive bladder tumors.
Fifty-four patients were enrolled: Ta (15 cases), T1 (27 cases) carcinoma in situ (CIS) alone (12 cases) or associated (14 cases). Urine cytology was of high grade and a second look was systematically performed in case of lamina propria infiltration. Initial therapy with 6 intravesical BCG instillations (81 mg) was performed with histologic and endoscopic bladder evaluation 3 months after initial resection using hexylaminolevulinate fluorescence (Hexvix(®) 85 mg).
Urine cytology was negative in 27 cases, suspicious in 12 cases and positive in 15 cases. With standard endoscopy under white light, mucosal bladder was normal in 32 cases, the use of fluorescence detected 8 tumour lesions confirmed with histology (CIS). When mucosal bladder was suspect under white light (22 patients), fluorescence was positive in 16 cases with 10 matching histological analysis (CIS and/or residual tumoral lesion). Therefore, despite high false positive rate with persistent mucosal bladder inflammation (38%), fluorescence guided endoscopy has allowed the diagnosis of suspect lesions not detected with white light with negative urine cytology.
Hexvix(®) fluorescence after intravesical BCG instillations may improve persistent carcinoma in situ detection when performed 3 months after induction treatment. However, a multicenter prospective study will be necessary in future to confirm these preliminary results.
这项回顾性研究的目的是评估卡介苗（BCG）治疗后膀胱镜检查中荧光在非侵袭性膀胱肿瘤管理中的作用。
共纳入54例患者：Ta期（15例）、T1期（27例）、单纯原位癌（CIS，12例）或合并其他情况（14例）。尿液细胞学检查为高级别，若存在固有层浸润则系统地进行二次检查。初始治疗采用6次膀胱内灌注BCG（81毫克），在初次切除术后3个月使用氨基乙酰丙酸己酯荧光（Hexvix® 85毫克）进行组织学和膀胱内镜评估。
27例患者尿液细胞学检查为阴性，12例可疑，15例阳性。在白光下的标准内镜检查中，32例患者的膀胱黏膜正常，荧光检查发现8处经组织学证实的肿瘤病变（CIS）。当白光下膀胱黏膜可疑时（22例患者），16例荧光检查呈阳性，其中10例与组织学分析相符（CIS和/或残留肿瘤病变）。因此，尽管持续性膀胱黏膜炎症导致假阳性率较高（38%），但荧光引导的内镜检查能够诊断出尿液细胞学检查阴性且白光下未发现的可疑病变。
膀胱内灌注BCG后使用Hexvix®荧光检查，在诱导治疗3个月后进行时，可能会提高原位癌的持续检测率。然而，未来有必要进行多中心前瞻性研究以证实这些初步结果。
5级
