Early detection of urothelial premalignant lesions using hexaminolevulinate fluorescence cystoscopy in high risk XXXX .

@entity1 @entity2735 @entity5 @entity75 @entity150 @entity29721 @entity2335 @entity1141
BACKGROUND: To evaluate fluorescence cystoscopy with @entity29721 (HAL) in the early detection of @entity1141 ( @entity1141 ) and @entity2735 ( @entity2735 ) in select high risk @entity1 . METHODS: We selected 30 consecutive @entity150 @entity1 at high risk for progression. After endoscopic resection, all @entity1 received (a) induction BCG schedule when needed, and (b) white light and fluorescence cystoscopy after 3 months. HAL at doses of 85 mg (GE Healthcare, Buckinghamshire, United Kingdom) dissolved in 50 ml of solvent to obtain an 8 mmol/L solution was instilled intravesically with a 12 Fr catheter into an empty bladder and left for 90 minutes. The solution was freshly prepared immediately before instillation. Cystoscopy was performed within 120 minutes of bladder emptying. Standard and fluorescence cystoscopy was performed using a double light system (Combilight PDD light source 5133, Wolf, Germany) which allowed an inspection under both white and blue light. RESULTS: The overall incidence was 43.3% @entity1141 , 23.3% @entity2735 , and 13.3% superficial transitional cell @entity5 . In 21 @entity1 , HAL cystoscopy was positive with one or more fluorescent flat lesions. Of the positive cases, there were 4 @entity2735 , 10 @entity1141 , 2 association of @entity2735 and @entity1141 , 4 well-differentiated non-infiltrating @entity150 , and 1 chronic @entity2335 . In 9 @entity1 with negative HAL results, random biopsies showed 1 @entity2735 and 1 @entity1141 . HAL cystoscopy showed 90.1% sensitivity and 87.5% specificity with 95.2% positive predictive value and 77.8% negative predictive value. CONCLUSION: Photodynamic diagnosis should be considered a very important tool in the diagnosis of potentially evolving flat lesions on the bladder mucosa such as @entity1141 and @entity2735 . Moreover, detection of @entity75 that are considered precursors of @entity2735 may play an important role in preventing disease progression. In our opinion, HAL cystoscopy should be recommended in the early follow-up of high risk @entity1 .
