Photodynamic diagnosis (5-aminolevulinic acid) of transitional cell carcinoma after bacillus Calmette-Guérin immunotherapy and mitomycin C intravesical therapy

Ronald O P Draga, Matthijs C M Grimbergen, Esther T Kok, Trudy N Jonges, Christiaan F P van Swol, J L H Ruud Bosch

Research output: Contribution to journalArticle (Academic Journal)peer-review

41 Citations (Scopus)

Abstract

BACKGROUND: Photodynamic diagnosis (PDD) is a technique that enhances the detection of occult bladder tumors during cystoscopy using a fluorescent dye.

OBJECTIVE: To study the differential effects of bacillus Calmette-Guérin (BCG) and mitomycin C (MMC) intravesical therapy on the false-positive rate of PDD of bladder cancer.

DESIGN, SETTING, AND PARTICIPANTS: This study included 552 procedures and 1874 biopsies.

INTERVENTION: Tumors were resected and biopsies were taken from suspicious areas, under guidance of white-light endoscopy and 5-ALA (5-aminolevulinic acid)-induced fluorescence cystoscopy.

MEASUREMENTS: The influence of intravesical BCG immunotherapy and intravesical MMC chemotherapy on pyuria, inflammation, and PDD specificity was examined in univariate analyses.

RESULTS AND LIMITATIONS: BCG significantly results in inflammation (odds ratio [OR]: 1.53, p=0.002), leukocyturia (OR: 1.84, p=0.034), and false positives in PDD (OR: 1.49, p=0.001). However, a single BCG instillation within 3 mo before PDD is most likely not associated with increased false-positive rates (OR: 0.35, p=0.26). Leukocyturia normalizes within 6 wk after the last BCG instillation, but PDD specificity is reduced up to 3 mo.

CONCLUSIONS: BCG is an important predictor for false positives in PDD (5-ALA). More than one BCG instillation within 3 mo before fluorescence cystoscopy decreases the specificity of PDD.

Original languageEnglish
Pages (from-to)655-60
Number of pages6
JournalEuropean Urology
Volume57
Issue number4
DOIs
Publication statusPublished - Apr 2010

Bibliographical note

Copyright © 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Keywords

  • Administration, Intravesical
  • Aminolevulinic Acid
  • Antibiotics, Antineoplastic
  • BCG Vaccine
  • Biopsy
  • Carcinoma, Transitional Cell
  • Cystoscopy
  • False Positive Reactions
  • Female
  • Humans
  • Inflammation
  • Leukocyte Count
  • Logistic Models
  • Male
  • Mitomycin
  • Neoplasm Staging
  • Netherlands
  • Odds Ratio
  • Predictive Value of Tests
  • Pyuria
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sensitivity and Specificity
  • Time Factors
  • Treatment Outcome
  • Urinary Bladder Neoplasms
  • Urine

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