Fluorescence detection of bladder tumors with 5-amino-levulinic acid.
BACKGROUND
Preliminary data suggest that photodiagnosis by fluorescence detection of protoporphyrin IX, a biosynthetic product of the photosensitizer 5-amino-levulinic acid (ALA), is superior to conventional cystoscopy in bladder tumor detection.


METHODS
We instilled 1.5 g of ALA into the bladders of 52 patients with suspect bladder lesions 1 to 4 hours prior to transurethral resection or biopsy. Red fluorescence was induced by violet-blue light (wavelength 380-450 nm).


RESULTS
In 13 patients (25%), significant tumors were detected by fluorescence that were missed on conventional cystoscopy. In the present series, ALA photodetection had a sensitivity of 94.6% (compared with 76% for cystoscopy) and a specificity of 43%.


CONCLUSIONS
Fluorescence diagnosis with ALA may become a standard procedure for bladder tumor detection and resection, especially in endoscopically difficult situations (carcinoma in situ, multifocal tumors, multiple prior resections, or previous drug instillation therapy).
Riedl
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CR
Department of Urology and Ludwig-Boltzmann-Institute for Urology and Andrology, Municipal Hospital Lainz, Vienna, Austria. ric@khl.uro.magwien.gv.at
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Pflüger
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D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid; D003558:Cystoscopy; D005453:Fluorescence; D006801:Humans; D008875:Middle Aged; D017319:Photosensitizing Agents; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000473:pathology*
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid