title: The sensitivity of fluorescent-light cystoscopy for the detection of carcinoma in situ (CIS) of the bladder: a meta-analysis with comments on gold standard.
abstract: What's known on the subject? and What does the study add? Fluorescent-light cystoscopy has a high sensitivity, relative to that of white light cystoscopy, for carcinoma in situ of the bladder. However, this systematic review reveals that the absolute sensitivity is unknown due to the absence of proper gold standard which is microscopic examination of whole bladders. •  A literature search was conducted to identify peer-reviewed study reports on the sensitivity of fluorescent-light cystoscopy (FLC) for the detection of carcinoma in situ (CIS) of the bladder. •  Data from 16 original studies comprising 1503 patients were pooled. •  The claimed sensitivity of FLC for detecting patients with CIS using the most commonly reported intravesical agents 5-aminolevulinic acid or hexaminolevulinic acid was 92.4%, while that of white-light cystoscopy (WLC) was 60.5%. The two agents did not differ significantly for sensitivity. •  It must be pointed out that a 'gold standard' is lacking in FLC studies. •  The occurrence of CIS of the bladder can only be established by the pathological examination of whole bladders. The true sensitivities of various modes of cystoscopy for detecting CIS can be revealed if patients scheduled for cystectomy are first examined with WLC, FLC, and optionally random biopsies. •  The absolute sensitivity of FLC for detecting CIS of the bladder is not yet known.
authors.affiliation: Department of Pathology, Telemark Hospital, Skien, Norway. isfoss@mac.com
authors.forename: Björn L
authors.initials: BL
authors.lastname: Isfoss
mesh_terms: D000622:Aminolevulinic Acid; D002278:Carcinoma in Situ / Q000473:pathology*; D003558:Cystoscopy / Q000379:methods*; D005453:Fluorescence; D006801:Humans; D008029:Lighting / Q000379:methods; D017319:Photosensitizing Agents; D001749:Urinary Bladder Neoplasms / Q000473:pathology*
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid