title: Feasibility of photodynamic diagnosis for challenging TUR- Bt cases including muscle invasive bladder cancer, BCG failure or 2nd-TUR.
abstract: BACKGROUND
  Despite widely adopted standard methods for follow-up including cystoscopy plus cytology, recurrence rates of non muscle-invasive bladder cancer (NMIBC) have not improved over the past decades, still ranging from 60% through 70%. Hence, widely acceptable surveillance strategies with excellent sensitivity are needed. Early recurrence has led to the development of a novel cystoscopy technique utilizing photodynamic diagnosis (PDD). Although, no studies have evaluated the efficacy of PDD for patients of MIBC, BCG failure or 2nd-transurethelial resection (TUR).
  
  
  METHODS
  The present study was performed from October 2012 through May 2013. IRB approved 25 patients initially underwent a cystoscopy examination of white light and blue light followed by the resection of tumors identified. Resections were performed from bladder mucosa areas considered suspicious at PDD, along with PDD negative normal bladder mucosa area resected by random biopsy. Specimens were divided into two groups, PDD positive and negative. Primary endpoints were sensitivity and specificity.
  
  
  RESULTS
  A total of 147 specimens extracted from 25 patients were included in the analysis. Some 45 out of 92 PDD-positive specimens were confirmed to have bladder cancer, and 51 out of PDD-negative 55 specimens were confirmed to be cancer negative. The sensitivity of PDD was 91.8% (45/49) and specificity was 52.0% (51/98). The sensitivity:specificity was 89.5% (17/19) : 47.6% (30/63) in 12 2nd-TUR patients, 90.5% (19/21) : 61.1% (11/18) in seven MIBC patients, and 95.0% (19/20) : 48.5% (16/33) in eight failed BCG cases.
  
  
  CONCLUSIONS
  PDD-TURBT has high sensitivity to diagnose BC even for 2nd-TUR, MIBC or BCG failure cases.
authors.affiliation: Department of Urology, University Hospital, Osaka Medical College, Osaka, Japan E-mail : tinamoto@poh.osaka-med.ac.jp.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Takai
authors.forename: Teruo
authors.initials: T
authors.lastname: Inamoto
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Komura
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: Taizo
authors.initials: T
authors.lastname: Uchimoto
authors.forename: Kenkichi
authors.initials: K
authors.lastname: Saito
authors.forename: Naoki
authors.initials: N
authors.lastname: Tanda
authors.forename: Junko
authors.initials: J
authors.lastname: Kouno
authors.forename: Koichiro
authors.initials: K
authors.lastname: Minami
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Uehara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Takahara
authors.forename: Hajime
authors.initials: H
authors.lastname: Hirano
authors.forename: Hayahito
authors.initials: H
authors.lastname: Nomi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kiyama
authors.forename: Haruhito
authors.initials: H
authors.lastname: Azuma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000628:therapy; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000175:diagnosis* / Q000628:therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D009367:Neoplasm Staging; D017319:Photosensitizing Agents; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000628:therapy
chemical_list: D001500:BCG Vaccine; D017319:Photosensitizing Agents