title: Positive urine cytology but negative white-light cystoscopy: an indication for fluorescence cystoscopy?
abstract: OBJECTIVE
  To evaluate the possible benefit of fluorescence cystoscopy (FC) in detecting cytologically 'confirmed' lesions when assessing urothelial carcinoma of the bladder, as negative white-light cystoscopy in cases of a positive cytological finding represents a diagnostic dilemma.
  
  
  METHODS
  From January 1996 to December 2006, 348 patients, who had cystoscopy for surveillance or due to suspicion of urothelial carcinoma, presented with an entirely negative white-light cystoscopy at our hospital. However, 77 of the 348 patients (22.2%) were diagnosed with a positive cytological finding. All patients had white-light cystoscopy first and a bladder-wash cytological specimen was obtained, then FC, followed by cold-cup biopsies and/or transurethral resection of the bladder tumour.
  
  
  RESULTS
  In the 77 patients with a positive cytological specimen FC enabled the detection of the precise site of malignancy within the bladder in 63 (82%). As malignant or premalignant lesions, there were 18 moderate dysplasias, 27 carcinoma in situ (CIS), and 18 pTa-1/G1-3 tumours. Moreover using FC, malignant or premalignant lesions were detected in 43 of 271 patients (15.9%) who had a negative cytological specimen (15 moderate dysplasias, six CIS, 22 pTa-1/G1-3).
  
  
  CONCLUSIONS
  This study shows that FC is beneficial in the detection of malignant and premalignant lesions, if there is negative white-light cystoscopy but positive urine cytology. The immediate identification of the exact site of a malignant lesion during FC enables the physician to diagnose and treat these patients more accurately and with no delay.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, LMU, Munich, Germany. alexander.karl@med.unimuenchen.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Stefan
authors.initials: S
authors.lastname: Tritschler
authors.forename: Peter
authors.initials: P
authors.lastname: Stanislaus
authors.forename: Christian
authors.initials: C
authors.lastname: Gratzke
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Frank
authors.initials: F
authors.lastname: Strittmatter
authors.forename: Ruth
authors.initials: R
authors.lastname: Knüchel
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Dirk
authors.initials: D
authors.lastname: Zaak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology; D003558:Cystoscopy / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence / Q000379:methods; D008875:Middle Aged; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014556:Urine / Q000166:cytology; D055815:Young Adult