title: Photodynamic diagnosis (5-aminolevulinic acid) of transitional cell carcinoma after bacillus Calmette-Guérin immunotherapy and mitomycin C intravesical therapy.
abstract: 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.
authors.affiliation: Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands. r.draga@umcutrecht.nl
authors.forename: Ronald O P
authors.initials: RO
authors.lastname: Draga
authors.forename: Matthijs C M
authors.initials: MC
authors.lastname: Grimbergen
authors.forename: Esther T
authors.initials: ET
authors.lastname: Kok
authors.forename: Trudy N
authors.initials: TN
authors.lastname: Jonges
authors.forename: Christiaan F P
authors.initials: CF
authors.lastname: van Swol
authors.forename: J L H Ruud
authors.initials: JL
authors.lastname: Bosch
mesh_terms: 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
chemical_list: D000903:Antibiotics, Antineoplastic; D001500:BCG Vaccine; D016685:Mitomycin; D000622:Aminolevulinic Acid