Photodynamic diagnosis (5-aminolevulinic acid) of transitional cell carcinoma after bacillus Calmette-Guérin immunotherapy and mitomycin C intravesical therapy.
BACKGROUND
Photodynamic diagnosis (PDD) is a technique that enhances the detection of occult bladder tumors during cystoscopy using a fluorescent dye.


OBJECTIVE
To study the differential effects of bacillus Calmette-Guérin (BCG) and mitomycin C (MMC) intravesical therapy on the false-positive rate of PDD of bladder cancer.


METHODS
This study included 552 procedures and 1874 biopsies.


METHODS
Tumors were resected and biopsies were taken from suspicious areas, under guidance of white-light endoscopy and 5-ALA (5-aminolevulinic acid)-induced fluorescence cystoscopy.


METHODS
The influence of intravesical BCG immunotherapy and intravesical MMC chemotherapy on pyuria, inflammation, and PDD specificity was examined in univariate analyses.


CONCLUSIONS
BCG significantly results in inflammation (odds ratio [OR]: 1.53, p=0.002), leukocyturia (OR: 1.84, p=0.034), and false positives in PDD (OR: 1.49, p=0.001). However, a single BCG instillation within 3 mo before PDD is most likely not associated with increased false-positive rates (OR: 0.35, p=0.26). Leukocyturia normalizes within 6 wk after the last BCG instillation, but PDD specificity is reduced up to 3 mo.


CONCLUSIONS
BCG is an important predictor for false positives in PDD (5-ALA). More than one BCG instillation within 3 mo before fluorescence cystoscopy decreases the specificity of PDD.
Draga
Ronald O P
RO
Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands. r.draga@umcutrecht.nl
Grimbergen
Matthijs C M
MC
Kok
Esther T
ET
Jonges
Trudy N
TN
van Swol
Christiaan F P
CF
Bosch
J L H Ruud
JL
D000283:Administration, Intravesical; D000622:Aminolevulinic Acid; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000009:adverse effects; D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D003558:Cystoscopy; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007249:Inflammation / Q000139:chemically induced; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects; D009367:Neoplasm Staging; D009426:Netherlands; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011776:Pyuria / Q000139:chemically induced; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D014556:Urine / Q000166:cytology
D000903:Antibiotics, Antineoplastic; D001500:BCG Vaccine; D016685:Mitomycin; D000622:Aminolevulinic Acid