Fluorescence cystoscopy improves detection of early bladder cancer

Fluorescence cystoscopy with hexaminolevulinate (HAL), a photosensitizing agent, is better than standard cystoscopy at detecting bladder carcinoma in situ, European researchers report.

Bladder carcinoma in situ (CIS) is difficult to detect with standard cystoscopy because these lesions are flat, senior author Dr. Michael Marberger, from the University of Vienna, and colleagues note. Fluorescent techniques are useful because they make these flat lesions light up, thereby improving detection, they add.The new findings, which are published in The Journal of Urology for January, are based on a study of 211 patients with symptoms suggestive of bladder cancer who were evaluated with both standard and HAL fluorescence cystoscopy.In each patient, 50 mL of HAL solution was instilled into the bladder and left in place for about 1 hour. The bladder was then evacuated and both types of cystoscopy were performed.Overall, 83 patients had bladder CIS, the authors note. Although most of the lesions were detected with both standard and HAL cystoscopy, in 18 patients, CIS was detected only with HAL cystoscopy. In contrast, standard cystoscopy was the sole means of CIS detection in just 2 patients. In one patient, CIS was detected by nonguided biopsy.The results suggest that HAL cystoscopy can identify 28% more CIS cases than can standard cystoscopy, the researchers state. Moreover, HAL instillation appears safe with negligible side effects.The improved detection achieved with HAL cystoscopy could have “consequences for clinical management and may improve the patient prognosis,” the authors note. The current study was funded by Oslo, Norway-based PhotoCure ASA, which produces HAL under the trade name Hexvix. (Source: J Urol 2004;171:135-138: Reuters Health: February 6th 2004: Oncolink)