Integral spectrophotometric analysis of 5-aminolaevulinic acid-induced fluorescence cytology of the urinary bladder.
OBJECTIVE
To evaluate whether tumour cells can be detected in bladder lavage fluid samples by an objective spectrofluorometric method, as 5-aminolaevulinic acid (ALA)-induced fluorescence endoscopy (AFE) and cytology are promising valuable tools for detecting transitional cell carcinoma of the urinary bladder (TCCB).


METHODS
After instilling ALA into the urinary bladder, lavage samples were collected and their sediments analysed spectroscopically under blue excitation at approximately 400 nm wavelength. During AFE, biopsies were taken. From 62 cases, 24 patients had a histologically confirmed TCCB (group A), 28 had a history of TCCB but no evidence of disease (group B) and 10 were negative for TCCB (group C).


RESULTS
Lavage sediments of all patients fluoresced in the green spectral range, typical of cellular autofluorescence. Sediments of all patients of group A caused red fluorescence peaking at 635 nm, indicating protoporphyrin IX (PPIX). The PPIX signals derived from bleaching spectra were significantly different between benign and malignant findings (P = 0.001). There was another red fluorescence peak at approximately 620 nm; in 19 cases its intensity exceeded the intensity of the PPIX signal.


CONCLUSIONS
Spectrofluorometric analysis of lavage sample sediments can be used to detect tumour-associated red fluorescence of PPIX in TCCB. Immediate significant and objective measurements are possible, which could be further automated for the rapid diagnosis of TCCB.
Tauber
Stephan
S
Urologische Klinik und Poliklinik, and Laser-Forschungslabor, Klinikum Grosshadern der Universität München, Germany. Stephan.Tauber@med.uni-muenchen.de
Stepp
Herbert
H
Meier
Richard
R
Bone
Agneta
A
Hofstetter
Alfons
A
Stief
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid; D002295:Carcinoma, Transitional Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017319:Photosensitizing Agents; D011524:Protoporphyrins; D012680:Sensitivity and Specificity; D013050:Spectrometry, Fluorescence / Q000379:methods; D007507:Therapeutic Irrigation / Q000379:methods; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology*
D017319:Photosensitizing Agents; D011524:Protoporphyrins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX