title: Diagnosis of upper urinary tract tumours: is photodynamic diagnosis assisted ureterorenoscopy required as an addition to modern imaging and ureterorenoscopy?
abstract: OBJECTIVE
  We aimed to assess the diagnostic accuracy of photodynamic diagnostic ureterorenoscopy (PDD-FURS) in detection of UUT-TCC in comparison with CT Urogram (CTU) and WL-FURS.
  
  
  METHODS
  Between June 2009 and August 2011, 30 patients underwent PDD-FURS after CTU for suspicion of UUT-TCC. Ureterorenoscopy was performed for abnormal upper urinary tract on imaging. Oral 5-Aminolevulinic Acid (5-ALA) was used as a photosensitizer. All procedures were performed by single endourologist experienced in photodynamic diagnosis. The sensitivity, specificity, and detection rate of WL-FURS, PDD-FURS and CTU were calculated using the Meta-DiSc v1.4 programme. P values <0.05 were considered significant.
  
  
  RESULTS
  PDD-FURS detected more UUT-TCCs than CTU or WL-FURS (94% (16/17) vs. 76.5% (13/17) vs. 82% (14/17) respectively). PDD-FURS was not significantly more sensitive than CTU and WL-FURS to detect UUT-TCC (0.94 (95% CI: 0.71-0.99) vs. 0.82 (95% CI: 0.57-0.96) vs. 0.81 (95% CI: 0.54-0.96) respectively; PDD-FURS vs. CTU: P=0.249; PDD-FURS vs. WL-FURS: P=0.277). There was no difference in the specificity between PDD-FURS and WL-FURS (1.0 (95% CI: 0.75-1.0) and 1.0 (95% CI: 0.75-1.0) respectively) (P=1), while PDD-FURS was significantly more specific than CTU (CTU: 0.21 (95% CI: 0.05-0.51) (P<0.001). PDD-FURS picked up 3 cases of CIS, which was not seen on WL-FURL and CTU.
  
  
  CONCLUSIONS
  Oral 5-ALA induced PDD-FURS has a high sensitivity and specificity to detect lesions and a higher detection rate to diagnose UUT-TCC than WL-FURS and CTU. It appears to be the only tool to visualise UUT CIS lesions.
authors.affiliation: Department of Urology, Ninewells Hospital and Medical School, Dundee, UK. aboumarzouk@gmail.com
authors.forename: Omar M
authors.initials: OM
authors.lastname: Aboumarzouk
authors.forename: Edward
authors.initials: E
authors.lastname: Mains
authors.forename: Harry
authors.initials: H
authors.lastname: Moseley
authors.forename: Sławomir G
authors.initials: SG
authors.lastname: Kata
mesh_terms: D000368:Aged; D021542:Amino Acids, Neutral; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis*; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence; D064847:Multimodal Imaging; D017319:Photosensitizing Agents; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014567:Urography; D014571:Urologic Neoplasms
chemical_list: D021542:Amino Acids, Neutral; D017319:Photosensitizing Agents; C013809:5-aminovaleric acid