Clinical evaluation of a method for detecting superficial transitional cell carcinoma of the bladder by light-induced fluorescence of protoporphyrin IX following topical application of 5-aminolevulinic acid: Preliminary results

BACKGROUND AND OBJECTIVE: In bladder cancer, conventional white light endoscopic examination of the bladder does not provide adequate information about the presence of "flat" urothelial lesions such as carcinoma in situ. In the present investigation, we examine a new technique for the photodetection of such lesions by the imaging of protoporphyrin IX (PpIX) fluorescence following topical application of 5-aminolevulinic acid (ALA). STUDY DESIGN/MATERIALS AND METHODS: Several hours after bladder instillation of an aqueous solution of ALA in 34 patients, a Krypton ion laser or a filtered Xenon arc-lamp was used to excite PpIX fluorescence. Tissue samples for histological analysis were taken while observing the bladder wall either by means of a video camera, or by direct endoscopic observation. RESULTS: A good correlation was found between the PpIX fluorescence and the histopathological diagnosis. On a total of 215 biopsies, 143 in fluorescent and 72 in nonfluorescent areas, all visible tumors on white light cytoscopy appeared in a bright red fluorescence with the photodetection technique. In addition, this method permitted to discover 47 unsuspected carcinomatous lesions on white light observation, among which 40% were carcinoma in situ. CONCLUSION: PpIX fluorescence induced by instillation into the bladder of 5-ALA is an efficient method of mapping the mucosa in bladder carcinoma.

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Hubert van den Bergh, Georges Wagnières
1997
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https://infoscience.epfl.ch/record/109560?ln=fr

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Publications associées (26)

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Fluorescence

La fluorescence est une émission lumineuse provoquée par l'excitation des électrons d'une molécule (ou atome), généralement par absorption d'un photon immédiatement suivie d'une émission spontanée.

Cancer de la vessie

La paroi interne de la vessie est tapissée de cellules transitionnelles qui sont à l'origine de la plupart des cancers de la vessie. L'évolution et la prise en charge dépend beaucoup du caractère in

Spectroscopie de fluorescence

La spectroscopie de fluorescence, ou encore fluorimétrie ou spectrofluorimétrie, est un type de spectroscopie électromagnétique qui analyse la fluorescence d'un échantillon. Elle implique l'utilisatio

Usefulness of fluorescence photodetection of neoplastic urothelial foci in bladder cancer following intravesical instillation of delta-aminolevulinic acid (5-ALA)

Hubert van den Bergh, Georges Wagnières

An excellent knowledge of histopathological risk factors of superficial bladder transitional cell carcinoma is mandatory to establish the prognosis of the disease. Presence or absence of carcinoma in situ (CIS) in superficial bladder cancer is one of the most powerful risk indicators. This study examines the usefulness of fluorescence photodetection of neoplastic urothelial foci in bladder cancer following intravesical instillation of delta-aminolevulinic acid (5-ALA). Following bladder instillation of an aqueous solution of 5-ALA in 43 cases, a Krypton ion laser and a Xenon arc-lamp were successively used as excitation source of the PPIX fluorescence. Tissular samples were respectively taken during bladder wall photodetection, either by the means of a video camera, or under direct endoscopic observation. A good correlation was observed between the fluorescence findings and the histopathological diagnosis. On a total of 298 biopsies, 49/110 carcinomatous lesions were detected by the fluorescence, whose more than 36% were CIS. PPIX induced fluorescence with topical bladder instillation of 5-ALA is an efficient and useful method of mapping the mucosa in bladder carcinoma. Moreover, in case of a multifocal disease, this method seems very helpful in finding and treating any residual malignant spots at the end of a transurethral bladder resection.

1996

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Clinical value of fluorescence cystoscopy in the detection of superficial transitional cell carcinomas of the bladder

Hubert van den Bergh, Georges Wagnières

The prognosis of superficial bladder cancer in terms of local recurrence and transformation into invasive cancer is related to the multiplicity of tumor sites and the concomitant presence of "flat" tumours, such as dysplasia and carcinoma in situ. This study of 51 patients emphasizes the value of fluorescence cystoscopy in the early detection of superficial transitional cell carcinomas. This method is based on induction of fluorescence in carcinomatous sites which selectively accumulate an endogenous photosensitizer, protoporphyrin IX, in response to intravesical administration of its precursor, 5-aminolevulinic acid. The sensitivity of the method in the present series was close to 93%. Fluorescence cystoscopy is a simple and reliable method to map the bladder mucosa looking for areas of dysplasia and carcinoma in situ.

1997

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Fluorescence imaging photodetection of early cancer in the bronchi with mTHPC and in the bladder with ALA-induced protoporphyrin IX: preliminary clinical results

Hubert van den Bergh, Georges Wagnières

Clinical results obtained endoscopically with an imaging fluorescence photodetection apparatus based on the use of one excitation wavelength and detection of the fluorescence emission performed in two separate spectral windows are presented. Early cancer photodetection of micro-invasive and in situ carcinoma of the bronchial mucosa after intravenous injection of meso-tetrahydroxyphenylchlorin (m-THPC) was performed during sessions involving photodynamic therapy. Preliminary results are also presented in the context of detecting transitional cell carcinoma of the bladder performed by fluorescence imaging photodetection of protoporphyrin IX (PPIX) following topical application of 5-delta aminolevulinic acid (ALA).

1995

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