Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
BMC Urol. 2021 Dec 22;21(1):180. doi: 10.1186/s12894-021-00946-w.
To compare 5-aminolevulinic acid (5-ALA)-mediated photodynamic diagnosis (PDD) with narrow-band imaging (NBI) for cancer detection during transurethral resection of bladder tumour (TURBT).
Between June 2018 and October 2020, 114 patients and 282 lesions were included in the analysis. Patients were orally administered 5-ALA (20 mg/kg) 2 h before TURBT. The bladder was inspected with white light (WL), PDD, and NBI for each patient, and all areas positive by at least one method were resected or biopsied. The imaging data were then compared to the pathology results.
The sensitivities of WL, PDD, and NBI for detecting urothelial carcinoma were 88.1%, 89.6%, and 76.2%, respectively. The specificity, positive predictive value, and negative predictive value for detecting urothelial carcinoma were 47.5%, 80.9%, and 61.3%, respectively, for WL; 22.5%, 74.5%, and 46.2%, respectively, for PDD; and 46.3%, 78.2%, and 43.5%, respectively, for NBI. PDD was significantly more sensitive than NBI for all lesions (p < 0.001) and carcinoma in situ (CIS) lesions (94.6% vs. 54.1%, p < 0.001).
PDD can increase the detection rate of bladder cancer, compared to NBI, by greater than 10%. Therefore, 100% of CIS lesions can be detected by adding PDD to WL.
比较 5-氨基酮戊酸（5-ALA）介导的光动力诊断（PDD）与窄带成像（NBI）在经尿道膀胱肿瘤切除术（TURBT）中用于癌症检测的效果。
2018 年 6 月至 2020 年 10 月，共有 114 名患者和 282 个病灶纳入分析。患者在 TURBT 前 2 小时口服 5-ALA（20mg/kg）。对每位患者依次进行白光（WL）、PDD 和 NBI 检查，对至少一种方法呈阳性的所有区域进行切除或活检。然后将影像学数据与病理结果进行比较。
WL、PDD 和 NBI 检测尿路上皮癌的敏感度分别为 88.1%、89.6%和 76.2%。WL 检测尿路上皮癌的特异度、阳性预测值和阴性预测值分别为 47.5%、80.9%和 61.3%；PDD 分别为 22.5%、74.5%和 46.2%；NBI 分别为 46.3%、78.2%和 43.5%。PDD 对所有病灶（p<0.001）和原位癌（CIS）病灶（94.6% vs. 54.1%，p<0.001）的敏感度均显著高于 NBI。
与 NBI 相比，PDD 可使膀胱癌的检测率提高 10%以上。因此，通过将 PDD 与 WL 结合使用，可 100%检测出 CIS 病变。
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