Pd20-03 Diagnostic Performance of Photodynamic Diagnosis With Oral 5-Aminolevulinic Acid for Bladder and Upper Tract Urothelial Carcinoma: A Single-Center, Retrospective Analysis

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD20)1 May 2024PD20-03 DIAGNOSTIC PERFORMANCE OF PHOTODYNAMIC DIAGNOSIS WITH ORAL 5-AMINOLEVULINIC ACID FOR BLADDER AND UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE-CENTER, RETROSPECTIVE ANALYSIS Takeshi Sano, Takashi Yoshida, and Hidefumi Kinoshita Takeshi SanoTakeshi Sano , Takashi YoshidaTakashi Yoshida , and Hidefumi KinoshitaHidefumi Kinoshita View All Author Informationhttps://doi.org/10.1097/01.JU.0001009556.54476.eb.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Photodynamic diagnosis (PDD) is a method used to enhance the endoscopic detection of urothelial carcinoma (UC) in the bladder and upper tract. The bladder and upper tract exhibit structural and embryological differences, as well as variations in the risk of pathogen exposure; all of which may impact the diagnostic accuracy of PDD. This study aims to compare the diagnostic performance of PDD enhanced with oral 5-aminolaevulinic acid (5-ALA) between the bladder and upper tract, within a single institute; with the goal of facilitating the efficient clinical application of PDD. METHODS: This retrospective study included 20 patients who were suspected to have upper tract UC (UTUC) based on radiological images and urine cytology between June 2018 and January 2019; and 109 patients who were suspected to have bladder UC (BUC) based on cystoscopy and urine cytology between January 2019 and March 2023. Approximately, 5-ALA (20 mg/kg) was orally administered 2–4 hours before diagnostic cysto- or ureteroscopy. Sixty-three and 696 biopsy samples were collected from the 20 patients in UTUC group and 109 patients in BUC group, respectively; white light- and PDD imaging was used. Sensitivity, specificity, positive and negative predictive values of PDD in patients in the UTUC and BUC groups were evaluated. RESULTS: Sensitivity, specificity, positive and negative predictive values of PDD in patients in the UTUC and BUC groups were: 93.8 vs 70.0, 77.4 vs 71.5, 81.1 vs 67.3, and 92.3 vs 74.0%, respectively. Overall, PDD in UTUC exhibited a better diagnostic accuracy than in BUC (0.86 vs 0.71). Even though concerns about the cylindrical shape of the ureter and the complicated structure of the renal pelvis would negatively affect imaging, the positive predictive value was superior in PDD for patients in the UTUC group. Irregular urothelium in white light cystoscopy that was also positive in PDD imaging was often diagnosed as non-specific sub-urothelial immune cell infiltration, cystitis cystica, nephrogenic adenoma on pathological examination. CONCLUSIONS: The photodynamic diagnosis in the upper urinary tract exhibited a better overall diagnostic performance compared with that in the bladder. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e447 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Takeshi Sano More articles by this author Takashi Yoshida More articles by this author Hidefumi Kinoshita More articles by this author Expand All Advertisement PDF downloadLoading ...