Fluorescence detection of flat bladder carcinoma in situ after intravesical instillation of hypericin.
OBJECTIVE
We determined the sensitivity and specificity of detecting flat bladder carcinoma in situ through fluorescent detection after intravesical hypericin instillations.


METHODS
The study included 40 patients, of whom 26 presented with macroscopic visible tumor, 9 had a positive cytology without visible tumor and 5 underwent cystoscopy after bacillus Calmette-Guerin instillations (4) or radiotherapy (1). We instilled 40 ml. of a 8 microM. solution of hypericin intravesically for at least 2 hours. Fluorescence excitation with blue light was effective up to 16 hours after termination of the instillation.


RESULTS
All visible papillary tumors showed red fluorescence. In addition, 134 flat fluorescent areas were detected. Analysis of 281 biopsies from flat bladder wall indicated 93% sensitivity and 98.5% specificity for detecting carcinoma in situ. Visible lesions resulting from radiotherapy, chemotherapy or immunotherapy did not show any fluorescent signs and, therefore, did not induce false-positive readings. There were no signs of photobleaching during inspection and resection.


CONCLUSIONS
We report a simple yet comprehensive endoscopic method for early detection of bladder cancer, including carcinoma in situ. Hypericin induced fluorescence has a high sensitivity and specificity for detection of bladder transitional cell carcinoma, papillary and flat carcinoma in situ. When carcinoma in situ is suspected, this technique is highly recommended.
D'Hallewin
M A
MA
Division of Urology, Laboratory for Pharmaceutical Biology and Division of Biochemistry, University Hospital Gasthuisberg, K. U. Leuven, Leuven, Belgium.
De Witte
P A
PA
Waelkens
E
E
Merlevede
W
W
Baert
L
L
D000283:Administration, Intravesical; D000873:Anthracenes; D002278:Carcinoma in Situ / Q000473:pathology*; D002295:Carcinoma, Transitional Cell / Q000473:pathology; D005453:Fluorescence; D006801:Humans; D010569:Perylene / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000473:pathology*
D000873:Anthracenes; D017319:Photosensitizing Agents; D010569:Perylene; C004965:hypericin