Photodynamic Diagnosis (5-Aminolevulinic Acid) of Transitional Cell Carcinoma After Bacillus Calmette-Guérin Immunotherapy and Mitomycin C Intravesical Therapy

• Published in: European urology Vol. 57; no. 4; pp. 655 - 660
• Main Authors: Draga, Ronald O.P, Grimbergen, Matthijs C.M, Kok, Esther T, Jonges, Trudy N, van Swol, Christiaan F.P, Bosch, J.L.H. Ruud
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier 01-04-2010
• Subjects: Administration, Intravesical; Aminolevulinic Acid; Antibiotics, Antineoplastic - administration & dosage; Antibiotics, Antineoplastic - adverse effects; Bacterial diseases; BCG Vaccine - administration & dosage; BCG Vaccine - adverse effects; Biological and medical sciences; Biopsy; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - therapy; Cystoscopy; False Positive Reactions; Female; Human bacterial diseases; Humans; Infectious diseases; Inflammation - chemically induced; Leukocyte Count; Logistic Models; Male; Medical sciences; Mitomycin - administration & dosage; Mitomycin - adverse effects; Neoplasm Staging; Nephrology. Urinary tract diseases; Netherlands; Odds Ratio; Predictive Value of Tests; Pyuria - chemically induced; Retrospective Studies; Risk Assessment; Risk Factors; Sensitivity and Specificity; Time Factors; Treatment Outcome; Tuberculosis and atypical mycobacterial infections; Tumors of the urinary system; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - therapy; Urinary tract. Prostate gland; Urine - cytology; Urology; Netherlands; Intravesical therapy; Non–muscle invasive bladder cancer; Mitomycin C; Fluorescent cystoscopy; BCG; Antineoplastic agent; Nephrology; Fluorescence; Transitional cell carcinoma; Urology; Non-muscle invasive bladder cancer; 5-Aminolevulinic acid; Urinary bladder; Immunotherapy; Urinary system disease; Mitomycin; Cystoscopy; Urinary tract disease; Malignant tumor; Alkylating agent; Antibiotic; Treatment; Urinary system; Photodynamic diagnosis; Bladder disease; Intravesical administration; Non muscle invasive bladder cancer; Cancer
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2009.09.037

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.