The Evaluation of the Photodynamic Diagnosis in 115 Cases of Bladder Cancer

Abstract

‹Purpose› To evaluate the value of the photodynamic diagnosis (PDD) of bladder cancer with intravesical instillation of 5-aminolevulinic acid (5-ALA).
‹material and method› In 115 patients with bladder cancer, PDD was performed. Two to two half hours prior to transurethral biopsy 15.g 5-ALA dissolved in 50 ml of 8.4% sodium hydrogen carbonate (NaHCO₃) solution was instilled intravesically. The level in images of the fluorescence were compared with pathological result. The area under the receiver operative characteristic curve (AUC) in PDD was compared with that in white light endoscopy.
‹Result› Among the 807 specimens obtained by transurethral biopsy, 276 specimens (34.2%) were pathologically diagnosed malignant epithelium, including 58 specimens (7.2%) with carcinoma in situ and 47 specimens (5.8%) with dysplasia were detected pathologically, with a sensitivity of 94.5%, a specificity of 60.6% and a predictive accuracy of 66.6%. The AUC in blue light endoscopy was more than that in white light endoscopy in not only all cases (p=0.002) but also in polypoid lesion (p=0.001), non-polypoid lesion (p<0.001), non-papillary lesion (p<0.001), new cases (p=0.003) and recurrent case (p=0.226). Procedures were well tolerated by all patients with mild bladder irritability but no systemic side effect.
‹Conclusion› Photodynamic diagnosis with intravesically applied 5-ALA is effective in detecting bladder cancer, and is expected to become a standard in the detection program.