Clinical evaluation of a method for detecting superficial surgical transitional cell carcinoma of the bladder by light-induced fluorescence of protoporphyrin IX following the topical application of 5-aminolevulinic acid: preliminary results.
OBJECTIVE
In bladder cancer, conventional white light endoscopic examination of the bladder does not provide adequate information about the presence of "flat" urothelial lesions such as carcinoma in situ. In the present investigation, we examine a new technique for the photodetection of such lesions by the imaging of protoporphyrin IX (PpIX) fluorescence following topical application of 5-aminolevulinic acid (ALA).


METHODS
Several hours after bladder instillation of an aqueous solution of ALA in 34 patients, a Krypton ion laser or a filtered Xenon arc-lamp was used to excite PpIX fluorescence. Tissue samples for histological analysis were taken while observing the bladder wall either by means of a video camera, or by direct endoscopic observation.


RESULTS
A good correlation was found between the PpIX fluorescence and the histopathological diagnosis. On a total of 215 biopsies, 143 in fluorescent and 72 in nonfluorescent areas, all visible tumors on white light cytoscopy appeared in a bright red fluorescence with the photodetection technique. In addition, this method permitted to discover 47 unsuspected carcinomatous lesions on white light observation, among which 40% were carcinoma in situ.


CONCLUSIONS
PpIX fluorescence induced by instillation into the bladder of 5-ALA is an efficient method of mapping the mucosa in bladder carcinoma.
Jichlinski
P
P
Department of Urology, CHUV Hospital, Lausanne, Switzerland.
Forrer
M
M
Mizeret
J
J
Glanzmann
T
T
Braichotte
D
D
Wagnières
G
G
Zimmer
G
G
Guillou
L
L
Schmidlin
F
F
Graber
P
P
van den Bergh
H
H
Leisinger
H J
HJ
D000279:Administration, Cutaneous; D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000008:administration & dosage; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis*; D005069:Evaluation Studies as Topic; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010779:Photofluorography; D017319:Photosensitizing Agents; D011524:Protoporphyrins; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*
D017319:Photosensitizing Agents; D011524:Protoporphyrins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX