Efficacy and Safety of Hexaminolevulinate Fluorescence Cystoscopy in the Diagnosis of Bladder Cancer
이재성, 이서연, 김우중, 서성일, 전성수, 이현무, 최한용, 정병창,
소속 상세정보
이재성 ( Lee Jae-Seung )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
이서연 ( Lee Seo-Yeon )
Kwandong University College of Medicine Myongji Hospital Department of Urology
김우중 ( Kim Woo-Jung )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
서성일 ( Seo Seong-Il )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
전성수 ( Jeon Seong-Soo )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
이현무 ( Lee Hyun-Moo )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
최한용 ( Choi Han-Yong )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
정병창 ( Jeong Byong-Chang )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
KMID : 0358320120530120821
Abstract
Purpose: The aim of this study was to evaluate the efficacy and safety of hexaminolevulinate fluorescence cystoscopy in the diagnosis of bladder cancer.
Materials and Methods: In a prospective design, we included patients who had a bladder lesion suggesting bladder cancer. Patients with massive hematuria, urethral Foley catheter insertion, chronic retention state, or urinary tract infection were excluded. After the bladder was emptied, hexaminolevulinate was gently administered into the bladder. One hour later, cystoscopy under white light and blue light was performed. After marking the lesions confirmed with white light or blue light, transurethral resection of the bladder lesion and pathologic confirmation were done. Transurethral resection of the lesions that were negative in both white and blue light was also performed.
Results: From April 2010 to September 2010, 30 patients were enrolled. From the total of 30 patients (25 men and 5 women; mean age, 60.4±9.22 years), 134 specimens were extracted. Among these, 101 specimens showed positive results by blue light cystoscopy (BLC). The sensitivity of BLC and white light cystoscopy (WLC) was 92.3% and 80.8%, respectively (p=0.021). The specificity of BLC and WLC was 48% and 49.1%, respectively (p>0.05). The positive and negative predictive values of BLC were 71.2% and 81.8%, respectively, whereas those of WLC were 72.0% and 68.6%, respectively. With WLC, 48 specimens showed negative findings, but of that group, 15 specimens (31.2%) were revealed to be malignant with BLC. There were no significant side effects in the 24 hours after the instillation of hexaminolevulinate.
Conclusions: Photodynamic diagnosis with hexaminolevulinate helps to find tumors that could be missed by use of WLC only. Photodynamic diagnosis might be valuable in complete resection as well as for more accurate diagnosis of bladder tumor.
키워드
Bladder cancer; Diagnostic imaging; Hemainolevulinate
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