Východisko. Fluorescenční diagnostika nabývá na významu v různých medicínských oborech. Metody a výsledky. Předkládáme výsledky srovnání cystoskopie v bílém světle s fluorescenční cystoskopií (modré světlo) po intravesikálním podání 1 g 5-aminolevulové kyseliny. Ze 63 vyšetřených osob byla shoda nálezu v bílém i modrém světle u 39 osob, ve 21 případech byl nález v modrém světle bohatší (10 osob) nebo patologický nález byl souhlasně s histologií zjištěn pouze v modrém světle (11 osob). Závěry. Při aplikaci 5-aminolevulové kyseliny nebyly pozorovány žádné vedlejší účinky, vůči pacientům je metoda šetrnější. Průzkum jasně prokázal přednosti fluorescenční diagnostiky.
Background. Fluorescence diagnosis has an increasing importance in differentmedical fields. In the presented paper, comparison of cystoscopy in white light with fluorescence cystoscopy after intravesical administration of 1 g of 5-aminolevulinic acid is presented. Methods and Results. From the group of 63 persons examined, no difference between findings in white and blue light was found in 39 cases. In 21 patients more pathological spotswere found in blue light (10 cases) or, in agreement with histology, pathology was detected in the blue light only (11 cases). Conclusions. The intravesical administration of 5-aminolevulinic acid had no side effects. Our study has definitely proved the advantages of fluorescence cystoscopy.
- MeSH
- Cystoscopy methods MeSH
- Adult MeSH
- Research Support as Topic MeSH
- Fluorescence MeSH
- Photochemotherapy MeSH
- Aminolevulinic Acid administration & dosage diagnostic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Urinary Bladder Neoplasms diagnosis pathology MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Review MeSH
- Comparative Study MeSH
- MeSH
- Cystoscopy methods instrumentation MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- MeSH
- Administration, Intravesical MeSH
- Cystoscopy methods utilization MeSH
- Research Support as Topic MeSH
- Carcinoma diagnosis surgery classification MeSH
- Aminolevulinic Acid administration & dosage diagnostic use MeSH
- Humans MeSH
- Urinary Bladder Neoplasms diagnosis surgery classification MeSH
- Prospective Studies MeSH
- Recurrence MeSH
- Neoplasm, Residual diagnosis MeSH
- Check Tag
- Humans MeSH
OBJECTIVE: To compare the value of flexible blue-light cystoscopy (BLC) vs flexible white-light cystoscopy (WLC) in the surveillance setting of non-muscle-invasive bladder cancer (NMIBC). METHODS: All major databases were searched for articles published before May 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was the accuracy of flexible BLC vs WLC in detecting bladder cancer recurrence among suspicious bladder lesions. RESULTS: A total of 10 articles, comprising 1634 patients, were deemed eligible for the quantitative synthesis. In the meta-analysis focusing on the detection of disease recurrence, there was no difference between flexible BLC and WLC (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.82-1.41)]; the risk difference (RD) showed 1% of flexible BLC, corresponding to a number needed to treat (NNT) of 100. In the subgroup meta-analysis of detection of carcinoma in situ (CIS) only, there was again no significant difference between flexible BLC and WLC (OR 1.19, 95% CI 0.82-1.69), BLC was associated with a RD of 2% (NNT = 50). The positive predictive values for flexible BLC and WLC in detecting all types of recurrence were 72% and 66%, respectively, and for CIS they were 39% and 29%, respectively. CONCLUSION: Surveillance of NMIBC with flexible BLC could detect more suspicious lesions and consequently more tumour recurrences compared to flexible WLC, with a increase in the rate of false positives leading to overtreatment. A total of 100 and 50 flexible BLC procedures would need to be performed to find on additional tumor and CIS recurences, respectively. A risk-stratified strategy for patient selection could be considered when using flexible BLC for the surveillance of NMIBC patients.
- MeSH
- Cystoscopy * methods MeSH
- Neoplasm Invasiveness MeSH
- Humans MeSH
- Neoplasm Recurrence, Local MeSH
- Non-Muscle Invasive Bladder Neoplasms MeSH
- Urinary Bladder Neoplasms * pathology diagnosis MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Comparative Study MeSH
- Systematic Review MeSH
CONTEXT: Non-muscle-invasive bladder cancer (NMIBC) is associated with a high recurrence risk, partly because of the persistence of lesions following transurethral resection of bladder tumour (TURBT) due to the presence of multiple lesions and the difficulty in identifying the exact extent and location of tumours using standard white-light cystoscopy (WLC). Hexaminolevulinate (HAL) is an optical-imaging agent used with blue-light cystoscopy (BLC) in NMIBC diagnosis. Increasing evidence from long-term follow-up confirms the benefits of BLC over WLC in terms of increased detection and reduced recurrence rates. OBJECTIVE: To provide updated expert guidance on the optimal use of HAL-guided cystoscopy in clinical practice to improve management of patients with NMIBC, based on a review of the most recent data on clinical and cost effectiveness and expert input. EVIDENCE ACQUISITION: PubMed and conference searches, supplemented by personal experience. EVIDENCE SYNTHESIS: Based on published data, it is recommended that BLC be used for all patients at initial TURBT to increase lesion detection and improve resection quality, thereby reducing recurrence and improving outcomes for patients. BLC is particularly useful in patients with abnormal urine cytology but no evidence of lesions on WLC, as it can detect carcinoma in situ that is difficult to visualise on WLC. In addition, personal experience of the authors indicates that HAL-guided BLC can be used as part of routine inpatient cystoscopic assessment following initial TURBT to confirm the efficacy of treatment and to identify any previously missed or recurrent tumours. Health economic modelling indicates that the use of HAL to assist primary TURBT is no more expensive than WLC alone and will result in improved quality-adjusted life-years and reduced costs over time. CONCLUSIONS: HAL-guided BLC is a clinically effective and cost-effective tool for improving NMIBC detection and management, thereby reducing the burden of disease for patients and the health care system. PATIENT SUMMARY: Blue-light cystoscopy (BLC) helps the urologist identify bladder tumours that may be difficult to see using standard white-light cystoscopy (WLC). As a result, the amount of tumour that is surgically removed is increased, and the risk of tumour recurrence is reduced. Although use of BLC means that the initial operation costs more than it would if only WLC were used, over time the total costs of managing bladder cancer are reduced because patients do not need as many additional operations for recurrent tumours.
- MeSH
- Cost-Benefit Analysis MeSH
- Time Factors MeSH
- Cystectomy economics methods standards MeSH
- Cystoscopy economics methods standards MeSH
- Models, Economic MeSH
- Neoplasm Invasiveness MeSH
- Quality of Life MeSH
- Quality-Adjusted Life Years MeSH
- Aminolevulinic Acid analogs & derivatives economics MeSH
- Humans MeSH
- Neoplasm Recurrence, Local MeSH
- Urinary Bladder Neoplasms economics pathology surgery MeSH
- Health Care Costs * MeSH
- Predictive Value of Tests MeSH
- Disease-Free Survival MeSH
- Disease Progression MeSH
- Neoplasm, Residual MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Practice Guideline MeSH
Cílem práce bylo posoudit vliv použití fluorescenční cystoskopie (FC) během transuretrální resekce (TUR) na četnost recidiv povrchových uroteliálních karcinomů močového měchýře. Pacienti byli randomizováni do 2 skupin. V 1. skupině byla TUR provedena běžným způsobem, zatímco ve skupině 2. za kontroly FC. Pacienti byli dále obvyklým způsobem sledováni, hodnocena byla četnost recidiv. Od 9/2001 do 9/2003 bylo zařazeno do souboru celkem 99 pacientů, z toho 49 do 1. skupiny a 50 do skupiny 2. Pozitivní nález při první kontrolní cystoskopii se objevil u 17 pacientů (34,7 %) v 1. skupině, respektive u 4 (8 %) ve skupině 2. Nižší riziko recidívy u pacientů, u nichž byla použita FC.je patrné v 1. roce po výkonu (p = 0,0573, Wilcoxonův zobecňovací test), zatímco při delším sledování se četnost recidiv v obou skupinách významně neliší (p = 0,1427, Log-Rank test). Použití FC v průběhu TUR povrchového tumoru močového měchýře snižuje riziko časných recidiv onemocnění.
The purpose of the work was to evaluate the influence of the use of fluorescence cytoscopy (FC) during transurethral resection (TUR) on the rate of recurrences of external urothelial urinary bladder carcinomas. The patients were randomized into two groups. In the first group the TUR was made in a standard way, while in the second one it was made under the control of FC. The patients were further monitored in standard way, evaluating the rate of recurrences. From September 2001 to September 2003 there were 99 patients involved in total, 49 of them to the first group and 50 to the second group. At the first control cystoscopy the positive finding was found at 17 patients (34,7 %) in first group, respectively at 4 (8%) in the second one. Lower risk of recurrence at patients where FC was used is evident during the first year after operation (p = 0,0573, Wilcoxons generalizing test), while during longer observation the rate of recurrences in the both groups does not significantly differ (p = 0,1427, Log-Rank test). The use of FC during TUR of external urinary bladder tumour lowers the risk of early recurrences of the disease.
- MeSH
- BCG Vaccine administration & dosage therapeutic use MeSH
- Cystoscopy methods MeSH
- Adult MeSH
- Research Support as Topic MeSH
- Fluorescence MeSH
- Carcinoma diagnosis pathology MeSH
- Aminolevulinic Acid administration & dosage diagnostic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Urinary Bladder Neoplasms pathology MeSH
- Recurrence MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Review MeSH
- Comparative Study MeSH
OBJECTIVE: To assess the influence of 5-aminolaevulinic acid-induced fluorescence cystoscopy (FC) during transurethral resection (TUR) on the recurrence rate and the length of tumour-free interval in stage Ta/T1 transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS: In all, 122 patients with primary or recurrent stage Ta/T1 bladder TCC treated with TUR were enrolled in a prospective randomized study. In group A the TUR was performed with standard white-light endoscopy, and in group B with FC. The patients were followed using standard cystoscopy and urinary cytology. The recurrence-free interval was evaluated in whole groups, for single and multiple, and for primary and recurrent tumours separately. RESULTS: At the time of the first cystoscopy (10-15 weeks after TUR) tumour recurrence was detected in 23 of 62 patients (37%) in group A, but only in five of 60 patients (8%) in group B. The recurrence-free survival rates in group A were 39% and 28% after 12 and 24 months, compared to 66% and 40% respectively in group B (P = 0.008, log-rank test). In separate analyses, the recurrence-free survival rates were significantly higher using FC in multiple (P = 0.001) and in recurrent (P = 0.02) tumours. In solitary and primary tumours the median time to recurrence was also longer in group B, but the difference was not statistically significant. CONCLUSION: 5-aminolaevulinic acid-induced FC during TUR reduces the recurrence rate in stage Ta/T1 bladder TCC. The most significant benefit is in patients with multiple and recurrent tumours.
- MeSH
- Cystoscopy methods MeSH
- Fluorescence MeSH
- Photosensitizing Agents diagnostic use MeSH
- Carcinoma, Transitional Cell diagnosis surgery MeSH
- Clinical Trials as Topic MeSH
- Aminolevulinic Acid diagnostic use MeSH
- Humans MeSH
- Neoplasm Recurrence, Local prevention & control MeSH
- Urinary Bladder Neoplasms diagnosis surgery MeSH
- Disease-Free Survival MeSH
- Prospective Studies MeSH
- Randomized Controlled Trials as Topic MeSH
- Risk Factors MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
Cílem práce je zhodnotit roli fluorescenční cystoskopie pří diagnostice nádorů močového měchýře. Od roku 1997 bylo na našem pracovišti provedeno celkem 125 fluorescenčních cystoskopií u 105 pacientů s podezřením na nádor močového měchýře. Kyselina 5-aminolevulová byla aplikována intravezikálně tenkým katétrem 1,5-3 hodiny před operací, k vyšetření byl použit zdroj excitačního světla firem Delong Instruments, respektive Olympus. Pacienti byli vyšetření v bílém i fialovém světle, exoíytické tumory byly resekovány a ze suspektních ložisek v obou zobrazeních byly odebrány biopsie. Celkem bylo histologicky vyšetřeno 437 vzorků tkáně. Fluorescenční cystoskopie dosáhla senzitivity 96,5 %, což bylo signifikantně více než 75,6 % u konvenčního vyšetření. Pouze díky fluorescenční cystoskopií se podařilo zachytit urotelíální nádor u 10 a dysplazie u 5 nemocných. Specificíta vyšetření v bílém světle činila 79,2 % oproti 65,7 % u fluorescenční cystoskopie. Fluorescenční cystoskopie představuje účinné doplnění konvenčního vyšetření při diagnostice urotelíálních papilokarcinomů močového měchýře.
The aim of the study is to evaluate the role of fluorescence cystoscopy in the diagnosis of urinary bladder tumours. 125 fluorescence cystoscopies altogether were done in 105 patients with suspeaed urinary bladder tumour in our hospital since 1997. 5-aminolevulic acid was instilled intravesically by a thin catheter 1,5-3 hours before the procedure, the source of excitation light used for investigations was produced by Delong Instruments resp. Olympus companies. Patients were investigated in both white and violet light, exophytic tumours were removed and biopsies were taken from suspeaed areas in both investigations. 437 specimens of the tissue were investigated. Fluorescence cystoscopy reached the sensitivity of 96.5%, which is significantly higher than 75.6 % in conventional investigation. Urotelial tumour was detected in 10 and dysplasia in 5 patients thanks fluorescence cystoscopy only. The specificity of white light investigation was 79.2% compared to 65.7 % in fluorescence cystoscopy. Fluorescence cystoscopy represents an effeaive supplement of conventional investígation in the diagnosis of urothelial papilocarcinomas of urinary bladder.
- MeSH
- Cystoscopy methods instrumentation MeSH
- Adult MeSH
- Research Support as Topic MeSH
- Fluorescence MeSH
- Aminolevulinic Acid administration & dosage diagnostic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Urinary Bladder Neoplasms diagnosis therapy MeSH
- Carcinoma, Papillary diagnosis MeSH
- Protoporphyrins MeSH
- Aged MeSH
- Sensitivity and Specificity MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Review MeSH
- Comparative Study MeSH
