ABSTRACT
UNLABELLED: White light cystoscopy (WLC) is considered to be a standard examination for localisation and surveillance of transitional cell cancer of urinary bladder. However, in patients who have undergone transurethral resection of bladder tumour (TUR-BT) sensitivity of this method is too low for early detection of cancer recurrence. In order to improve this unsatisfactory situation new diagnostic procedures are still under investigation. Fluorescent diagnosis is a modern diagnostic option based on the detection of distinctive fluorescence of normal and pathological tissue. Currently two techniques are in clinical use: autofluorescent diagnosis, also termed laser-induced fluorescence (LIF) and photodynamic diagnosis (PDD). In this study we have analysed sensitivity and specificity of the fluorescent diagnosis to validate the best mode of bladder cancer diagnosis. A total of 281 patients, after electroresection of bladder tumour due to transitional cell carcinoma, without any signs of tumour recurrence in white-light cystoscopy, were divided in two groups: 52 patients underwent PDD and in 229 patients autofluorescent diagnosis was performed. Bladder washings and excisions from suspicious red fluorescent spots were taken for histopathological and cytological analyses. Sensitivity and specificity of PDD equalled to 90.91 and 66.60%, respectively. In case of autofluorescence diagnosis these values amounted to: 97.83 and 70.07%, respectively. The overall sensitivity and specificity of fluorescent examination equalled to 96.49 and 69.46%, respectively. CONCLUSION: Autofluorescence diagnosis (LIF) of pathological lesions within urinary bladder has been proven to be more sensitive than PDD as evaluated by a non-parametrical test for structure indicators comparison (LIF versus PDD, P=0.0056).
ABSTRACT
INTRODUCTION: Transitional cell carcinoma (TCC) of the urinary bladder is nowadays one of the most common cancers in young men. Similarly to other cancers TCC can be treated with curative intent when it is diagnosed very early. In recent years there has been an intensive development of treatment methods of urological diseases based on modern scientific discoveries, one of which is photodynamic therapy (PDT). This treatment in urology may be used either for pre-cancerous lesions, carcinoma in situ or for superficial tumours. PATIENTS AND METHODS: In this study, patients were subjected to PDT with subsequent BCG-therapy. In our study we demonstrate cases of 14 patients, who were under observation for minimum 24 months. All patients were diagnosed as having TCC in pathological stage pT1N0M0 (clinical: T1NxM0). They had previously undergone transurethral resection of bladder tumour (TUR-BT) and no exophytic tumours were observed. Patients were instillated intravesically with 4.5g of ALA (aminolevulinic acid) in buffered solution in the bladder for 2h. Afterwards, within 2h the bladder was irradiated with 635nm an argon-pumped dye laser light. Light power on the tip of the fibre was 1.0W. The total energy dose was 2000J equally divided into two to three sessions. RESULTS: After 24-month observation total response was observed in eight patients (in histopathological examination urocystitis was diagnosed), partial response (low- or high-grade dysplasia in microscopic examination) in two patients and no response in four patients (cancer cells in excised specimens). CONCLUSIONS: :
ABSTRACT
BACKGROUND: The objective of our study was to determine therapeutic response to photodynamic therapy (PDT) and adverse reaction of PDT in 126 patients with 141 lesions: 36 patients with 41 lesions of superficial basal cell carcinoma (BCC), 35 patients with nodular BCC, 42 patients with ulcerated BCC, four patients with 14 lesions of actinic keratoses, five with superficial squamous cell carcinoma (SCC) and four with Bowen's disease. METHODS: Patients with skin malignancies were treated using 20% aminolevulinic acid (ALA) (Medac GmbH, Wedel, Germany) topically and light from an argon-pumped dye laser. RESULTS: A complete response was achieved in 81.5% treated lesions. A partial response after PDT in 10.6% treated lesions, no response in 7.8% treated lesions and 11.3% lesions recurrences during 10-36 months follow-up were observed. Following light exposure skin lesions became necrotic and showed hemorrhagic crusts and the cosmetic outcome was excellent or good in 97 of the completely responding lesions (84.3%). CONCLUSIONS: Clinical studies reported by other groups have shown similar high percentages of clinical cure. PDT appears to be a more feasible alternative to conventional therapy of skin malignancies.
