口服 5-氨基酮戊酸光动力诊断在上尿路和膀胱尿路上皮癌中的诊断性能：一项单中心回顾性分析。
Diagnostic performance of photodynamic diagnosis with oral 5-aminolevulinic acid for upper tract- and bladder urothelial carcinoma: a single-centre, retrospective analysis.
机构信息
Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata- shi, 573-1010, Osaka, Japan.
Department of Urology, Osaka Saiseikai-Noe Hospital, Osaka, Japan.
出版信息
World J Urol. 2024 Jul 10;42(1):389. doi: 10.1007/s00345-024-05083-1.
PURPOSE
To compare the diagnostic performance of photodynamic diagnosis (PDD) enhanced with oral 5-aminolaevulinic acid between the suspected upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BUC) cases.
METHODS
This retrospective study included 18 patients with suspected UTUC who underwent ureteroscopy (URS) with oral 5-ALA in the PDD-URS cohort between June 2018 and January 2019; and 110 patients with suspected BUC who underwent transurethral resection of bladder tumour (TURBT) in the PDD-TURBT cohort between January 2019 and March 2023. Sixty-three and 708 biopsy samples were collected during diagnostic URS and TURBT, respectively. The diagnostic accuracy of white light (WL) and PDD in the two cohorts was evaluated, and false PDD-positive samples were pathologically re-evaluated.
RESULTS
The area under the receiver operating characteristic curve (AUC) of PDD was significantly superior to that of WL in both cohorts. The per biopsy sensitivity, specificity, and positive and negative predictive values of PDD in patients in the PDD-URS and PDD-TURBT cohorts were 91.2 vs. 71.4, 75.9 vs. 75.3, 81.6 vs. 66.3, and 88.0 vs. 79.4%, respectively. The PDD-URS cohort exhibited a higher AUC than did the PDD-TURBT cohort (0.84 vs. 0.73). Seven of four false PDD-positive samples (57.1%) in the PDD-URS cohort showed potential precancerous findings compared with eight of 101 (7.9%) in the PDD-TURBT cohort.
CONCLUSION
The diagnostic performance of PDD in the PDD-URS cohort was at least equivalent to that in the PDD-TURBT cohort.
目的
比较经口服 5-氨基酮戊酸（5-ALA）增强的光动力诊断（PDD）在疑似上尿路尿路上皮癌（UTUC）与膀胱尿路上皮癌（BUC）病例中的诊断性能。
方法
本回顾性研究纳入了 2018 年 6 月至 2019 年 1 月期间接受 PDD-URS 的 18 例疑似 UTUC 患者，以及 2019 年 1 月至 2023 年 3 月期间接受 PDD-TURBT 的 110 例疑似 BUC 患者。诊断性输尿管镜检查（URS）和经尿道膀胱肿瘤切除术（TURBT）时分别采集了 63 和 708 个活检样本。评估了两组中白光（WL）和 PDD 的诊断准确性，并对假阳性的 PDD 样本进行了病理重新评估。
结果
两组中 PDD 的受试者工作特征曲线（ROC）下面积（AUC）均显著优于 WL。PDD-URS 和 PDD-TURBT 两组中，PDD 每例活检的敏感度、特异度、阳性预测值和阴性预测值分别为 91.2%比 71.4%、75.9%比 75.3%、81.6%比 66.3%和 88.0%比 79.4%。PDD-URS 组的 AUC 高于 PDD-TURBT 组（0.84 比 0.73）。PDD-URS 组的 4 个假阳性 PDD 样本中有 7 个（57.1%）显示出潜在的癌前病变，而 PDD-TURBT 组的 101 个样本中有 8 个（7.9%）显示出潜在的癌前病变。
结论
PDD-URS 组的诊断性能至少与 PDD-TURBT 组相当。
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