Document Detail

Hexylaminolaevulinate 'blue light' fluorescence cystoscopy in the investigation of clinically unconfirmed positive urine cytology.
MedLine Citation:
PMID:  19076151     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate the value of photodynamic diagnosis (PDD) using hexylaminolaevulinate (Hexvix, PhotoCure, Oslo, Norway) in the investigation of patients with positive urine cytology who have no evidence of disease after standard initial investigations. PATIENTS AND METHODS: Twenty-three patients referred with positive urine cytology but no current histological evidence of cancer were investigated between April 2005 and January 2007 with PDD, using Hexvix and the D-light system (Karl Storz, Tuttlingen, Germany) to detect fluorescence. The bladder was mapped initially under white light and then under 'blue-light'. Biopsies were taken from abnormal urothelium detected by white light, fluorescence, or both. All cytological specimens were reviewed by a reference cytopathologist unaware of the result of the PDD. RESULTS: Twenty-five PDD-assisted cystoscopies were carried out on 23 patients (20 men/3 women; median age 64 years, range 24-80 years). Of the 23 patients, 17 (74%) were previously untreated for transitional cell carcinoma (TCC), whilst six were under surveillance for previous TCC. Nineteen of the 23 (83%) cytology specimens were confirmed as suspicious or positive by the reference pathologist. TCC of the bladder or preneoplastic lesions were diagnosed in six patients, i.e. six (26%) of those investigated and six of 19 (32%) with confirmed positive cytology. Four of the six were under surveillance for previous bladder tumour. Additional pathology was detected by fluorescence in five of the six patients, including two carcinoma in situ (CIS), one CIS + G3pT1 tumour, and two dysplasia. Diagnoses in PDD-negative cases included one upper tract TCC and four patients with stones. In addition, one patient had CIS diagnosed on both white light and PDD 6 months later. CONCLUSION: Additional pathology was detected by HAL fluorescence cystoscopy in 32% of patients with confirmed positive urinary cytology. PDD is a key step in the management of patients with positive urinary cytology and no evidence of disease on conventional tests.
Eleanor R Ray; Kathryn Chatterton; Mohammed S Khan; Kay Thomas; Ashish Chandra; Tim S O'Brien
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-12-08
Journal Detail:
Title:  BJU international     Volume:  103     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-20     Completed Date:  2009-06-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  1363-7     Citation Subset:  IM    
Departments of Urology and Histopathology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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MeSH Terms
Aged, 80 and over
Aminolevulinic Acid / analogs & derivatives*,  diagnostic use,  standards
Carcinoma in Situ / diagnosis*
Carcinoma, Transitional Cell / diagnosis*
Cohort Studies
Cystoscopy / methods*,  standards
Microscopy, Fluorescence
Middle Aged
Photosensitizing Agents / diagnostic use*,  standards
Predictive Value of Tests
Sensitivity and Specificity
Urinary Bladder Neoplasms / diagnosis*
Young Adult
Reg. No./Substance:
0/5-aminolevulinic acid hexyl ester; 0/Photosensitizing Agents; 106-60-5/Aminolevulinic Acid

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