title: Outpatient diagnostic of bladder tumours in flexible cystoscopes: evaluation of fluorescence-guided flexible cystoscopy and bladder biopsies.
abstract: OBJECTIVE
  The aim of this study was to evaluate photodynamic diagnosis (PDD) in flexible cystoscopes and the diagnostic quality of biopsies for diagnosis of non-muscle-invasive bladder cancer in the outpatients department (OPD).
  
  
  METHODS
  Seventy-three patients (aged 36-91 years) with recurrent non-muscle-invasive bladder cancer and a medium to high risk of recurrence had a flexible PDD cystoscopy performed in the OPD. The bladder was first examined in standard white light followed by PDD.
  
  
  RESULTS
  PDD was superior to white light diagnosis; PDD was positive in 16 patients (22%) where white light showed a normal bladder mucosa. Four of these patients had bladder tumour [4/73, 6%; two carcinoma in situ (CIS), two Ta]. The diagnosis was verified by transurethral resection of the bladder tumour in the operating room. In 20 patients (20/73, 27%) PDD identified additional tumour lesions that were not identified in white light (five CIS, 15 Ta). The false-positive detection rate of PDD was 0.41. False positivity was significantly reduced by simultaneous flex biopsies disproving malignancy. Biopsies were obtained from 57 patients and diagnosis of stage and grade were possible in 55 of these (97%). In two patients (4%) the tissue material was too small for diagnostic evaluation. Biopsies from 47 patients (83%) included muscularis mucosa and from 20 patients (35%) muscularis propria. In 30 patients all but one diagnosis from the OPD was confirmed by biopsy in rigid scopes in the operating room.
  
  
  CONCLUSIONS
  PDD-guided cystoscopy and bladder biopsy in flexible cystoscopes can be performed in an OPD setting and with reliable results for diagnosis of tumour stage Ta, CIS and T1a bladder cancer.
authors.affiliation: Department of Urology, Copenhagen University, Frederiksberg Hospital, Copenhagen, Denmark. gregershermann@hotmail.com
authors.forename: Gregers G
authors.initials: GG
authors.lastname: Hermann
authors.forename: Karin
authors.initials: K
authors.lastname: Mogensen
authors.forename: Birgitte Grønkær
authors.initials: BG
authors.lastname: Toft
authors.forename: Anders
authors.initials: A
authors.lastname: Glenthøj
authors.forename: Helle M
authors.initials: HM
authors.lastname: Pedersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D003558:Cystoscopy / Q000295:instrumentation* / Q000379:methods; D005189:False Positive Reactions; D005453:Fluorescence; D006801:Humans; D008027:Light; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D010045:Outpatients; D015203:Reproducibility of Results; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*