Slawomir G Kata1, Omar M Aboumarzouk2, Abdullah Zreik3, Bhaskar Somani4, Sarfraz Ahmad5, Ghulam Nabi6, Ronald Buist7, Carol Goodman7, Piotr Chlosta8, Tomasz Golabek8, Harry Moseley9. 1. Department of Urology, Ninewells Hospital and Medical School, Dundee, UK; The Scottish Photodynamic Therapy Centre, Ninewells Hospital & Medical School, Dundee, UK. Electronic address: g.kata@nhs.net. 2. Department of Urology, Ninewells Hospital and Medical School, Dundee, UK; Department of Urology, Royal Gwent Hospital, Newport, Wales, UK; Islamic Universities of Gaza, College of Medicine, Gaza, Palestine. 3. Department of Urology, Gartnavel General Hospital, Glasgow, UK. 4. Department of Urology, Ninewells Hospital and Medical School, Dundee, UK; University Hospitals Southampton NHS Trust, Southampton, UK. 5. Department of Urology, Ninewells Hospital and Medical School, Dundee, UK. 6. Department of Urology, Ninewells Hospital and Medical School, Dundee, UK; Division of Imaging and Technology, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK. 7. The Scottish Photodynamic Therapy Centre, Ninewells Hospital & Medical School, Dundee, UK. 8. Academic Urological Unit, Collegium Medicum, Jagiellonski University, Krakow, Poland. 9. The Scottish Photodynamic Therapy Centre, Ninewells Hospital & Medical School, Dundee, UK; The Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK.
Abstract
BACKGROUND: Photodynamic diagnosis increases the detection rate and hence decreases recurrence rates of urothelial cancer (UC) of the bladder. This technique has been implemented in the upper urinary tract and like in the bladder, has shown to increase the detection rate of urothelial lesions. OBJECTIVES: To determine the sensitivity, specificity, and detection rates for photodynamic diagnostic flexible ureterorenoscopy (PDD-FURS) and white light ureterorenoscopy (WL-FURS). Design between 2009 and 2013, PDD-FURS was performed within 106 Upper urinary tract (UUT) Units (Mean age-72.6±9.5). Indications for the procedure included abnormal upper urinary tract on imaging, normal flexible cystoscopy with abnormal urine cytology, endoscopic treatment and follow-up of UUT UC. Oral 5-aminolevulinic acid was used as the photosensitizer administered 3-4 h pre-operatively. RESULTS: 48 lesions were detected, of which 95.8% (46/48) where visualised by PDD-FURS compared to 47.9% (23/48) shown by WL-FURS (P<0.0001). PDD-FURS detected significantly more carcinoma in situ (CIS) or dysplasia lesions than WL-FURS (93.75% (15/16) vs. 18.75% (3/16), respectively, (P=0.0006)). Furthermore, PDD-FURS detected significantly more UC lesions than WL-FURS (96.9% (31/32) vs. 62.5% (20/32) (P=0.007)). PDD-FURS was more sensitive (95.8; range: 85.7-99.5) than WL-FURS (53.5; range: 37.7-68.8) in detecting UUT-UC (P<0.0001). There was no difference (P=0.716) in the specificity between PDD-FURS (96.6; range: 88.1-99.6) and WL-FURS (95.2; range: 86.7-99). CONCLUSIONS: Our results PDD-FURS with oral 5-ALA as photosensitizer suggest higher sensitivity and detection rate of urothelial tumours than WL-FURS, with a good safety profile. In our series, PDD-FURS enhanced the visualisation of flat lesions, such as CIS and dysplasia that otherwise would have been missed.
BACKGROUND: Photodynamic diagnosis increases the detection rate and hence decreases recurrence rates of urothelial cancer (UC) of the bladder. This technique has been implemented in the upper urinary tract and like in the bladder, has shown to increase the detection rate of urothelial lesions. OBJECTIVES: To determine the sensitivity, specificity, and detection rates for photodynamic diagnostic flexible ureterorenoscopy (PDD-FURS) and white light ureterorenoscopy (WL-FURS). Design between 2009 and 2013, PDD-FURS was performed within 106 Upper urinary tract (UUT) Units (Mean age-72.6±9.5). Indications for the procedure included abnormal upper urinary tract on imaging, normal flexible cystoscopy with abnormal urine cytology, endoscopic treatment and follow-up of UUT UC. Oral 5-aminolevulinic acid was used as the photosensitizer administered 3-4 h pre-operatively. RESULTS: 48 lesions were detected, of which 95.8% (46/48) where visualised by PDD-FURS compared to 47.9% (23/48) shown by WL-FURS (P<0.0001). PDD-FURS detected significantly more carcinoma in situ (CIS) or dysplasia lesions than WL-FURS (93.75% (15/16) vs. 18.75% (3/16), respectively, (P=0.0006)). Furthermore, PDD-FURS detected significantly more UC lesions than WL-FURS (96.9% (31/32) vs. 62.5% (20/32) (P=0.007)). PDD-FURS was more sensitive (95.8; range: 85.7-99.5) than WL-FURS (53.5; range: 37.7-68.8) in detecting UUT-UC (P<0.0001). There was no difference (P=0.716) in the specificity between PDD-FURS (96.6; range: 88.1-99.6) and WL-FURS (95.2; range: 86.7-99). CONCLUSIONS: Our results PDD-FURS with oral 5-ALA as photosensitizer suggest higher sensitivity and detection rate of urothelial tumours than WL-FURS, with a good safety profile. In our series, PDD-FURS enhanced the visualisation of flat lesions, such as CIS and dysplasia that otherwise would have been missed.
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