Accuracy of photodynamic diagnosis in the detection and follow-up of patients with upper urinary tract lesions: Initial 3-year experience - PubMed (original) (raw)

Accuracy of photodynamic diagnosis in the detection and follow-up of patients with upper urinary tract lesions: Initial 3-year experience

Omar M Aboumarzouk et al. Arab J Urol. 2012 Jun.

Abstract

Objective: To assess the diagnostic accuracy of photodynamic diagnostic (PDD) ureterorenoscopy for detecting upper-urinary tract transitional cell carcinoma (UUT-TCC) in our initial 3 years, and compare the results with that of white light ureterorenoscopy (WLU).

Patients and methods: Between August 2007 and March 2010, 32 patients underwent PDD flexible ureterorenoscopy for UUT-TCC. Oral 5-aminolaevulinic acid (5-ALA) was used as the photosensitiser. The sensitivity, specificity and detection rate of PDD were calculated.

Results: The sensitivity, specificity, positive and negative predictive values of PDD for detecting abnormal tissue were 96%, 100%, 100% and 88%, compared to the results of WLU of 80%, 86%, 95% and 55%, respectively. PDD was able to detect 96% (24/25) of the abnormal tissue and 96% (21/22) of cancerous tissue, while WLU detected 80% (20/25) of abnormal tissue and 91% (20/22) of the tumour tissue. Three patients of the 32 (10%) developed side-effects related to 5-ALA; two patients developed a facial-skin photosensitive reaction and one developed hypotension. All were treated conservatively, with no long-term effects.

Conclusion: PDD can be used safely in the UUT, and with a higher sensitivity, specificity and detection rate than standard WLU for detecting UUT tumours.

Keywords: 5-ALA, 5-aminolaevulinic acid; 5-Aminolaevulinic acid; CIS, carcinoma in situ; Diagnosis; FN, false-negative; FP, false-positive; FURS, flexible ureterorenoscopy; Flexible ureterorenoscopy; P(N)PV, positive (negative) predictive value; PDD, photodynamic diagnosis; Photodynamic; TN, true-negative; TP, true-positive; TURBT, transurethral resection of bladder tumour; Transitional cell carcinoma; UUT, upper urinary tract; WL(U)(C), white-light (ureterorenoscopy) (cystoscopy).

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Figures

Figure 1

Figure 1

PDD using blue light, showing five areas of abnormal tissue.

Figure 2

Figure 2

WLU of the same area as in Fig. 1, showing two lesions.

Figure 3

Figure 3

PDD showing a single area of CIS.

Figure 4

Figure 4

WLU of the same area as in Fig. 3, showing no obvious lesion.

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