Photodynamic diagnosis of non-muscle invasive bladder cancer using hexaminolevulinic acid

Vol. 52 No. 1 Suppl., 2011
This supplement was not sponsored by Outside Organizations.


O. Dragoescu, P. Tomescu, A. Panus, M. Enache, C. Maria, L. Stoica, I. E. Plesea

Bladder cancer (BC) is the most common tumor of the urinary tract. White light cystoscopy (WLC) is currently considered the standard investigation for diagnosis of bladder tumors. Recent studies suggest that using exogenous fluorescence (photodynamic diagnosis, PDD) can improve its diagnostic sensitivity and specificity. Objective: Our study aims to analyze the value of using fluorescent cystoscopy (PDD) in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). Patients and Methods: The study designed as a prospective randomized clinical trial was conducted over a 12 months period and included 44 patients with primitive NMIBC diagnosed and treated in our department in 2009. Twenty-two patients were included in the study group (PDD), while 22 patients were diagnosed and treated by conventional methods (WLC). Results: There were no statistically significant differences between the two groups regarding age, sex, place of origin, smoking history, clinical symptoms or presence of urological history as well as tumor size, location or number. Fluorescence cystoscopy examination identified 25.8% more tumors than the conventional examination (p=0.004). We demonstrated a significant reduction of tumor recurrence rates at 3, 6, 9 and 12 months by using PDD (HR=0.3271, 95% CI 0.1091-0.9809; p=0.0461). Conclusions: The use of PDD in patients with NMIBC results in significant improvement of the efficiency of their initial diagnosis cystoscopy (by over 25%). We demonstrated improved patient prognosis and quality of life following conservative TUR treatment of these tumors by significantly reducing the tumor recurrence rate (by 9-27%) in the first year of follow-up.

Corresponding author: Octavian Dragoescu, Assistant, MD, PhD candidate, e-mail:

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D. Ghita, Aurelia Glavici, I. E. Plesea, A. Saftoiu, Daniela Dumitrescu, T. Ciurea

Introduction. Imagistic examinations have an essential role in the assessment of gastric cancer both in earlier and advanced stages. Among these, endoscopic ultrasound (EUS) especially contributes to the diagnosis by direct visualization of the tumor and to the staging and prognosis assessment through the evaluation of the gastric wall and regional lymph nodes. Computer tomography (CT) examination also has an important role, especially in advanced stages, in the assessment of the prognosis, contributing to TNM staging. The aim of this study is a comparative assessment of tumor invasion degree by these two imagistic methods and the correlation of the imagistic diagnosis with histopathologic assessment results on surgical specimens. Materials and Methods. The basis of the study was represented by a group of 38 patients with gastric carcinoma investigated both by endoscopic ultrasound and computer tomography from which 15 cases with surgical excision of the tumor followed by microscopic examination were selected. Studied material was represented by: patientsâ?? medical charts, registers for ultrasound endoscopy and CT investigation, endoscopic and CT images, surgical excision samples and pathology reports. Tumor fragments were processed by classical histological techniques (fixation and paraffin wax embedding) and staining (HE). Results. Comparing the CT examination with ultrasound endoscopy results showed that CT examination overestimated the invasion grade of the gastric wall (T) but accurately defined the grade of lymph node invasion (N) and metastases (M). Comparing the results of ultrasound endoscopic examination with those from histopathological examination showed that the first method underestimated the grade of invasion of the gastric wall (T) while the latter correctly defined the grade of lymph node invasion (N) and metastases (M). Comparing CT examination results with histopathological ones showed that CT overestimated both the grade of invasion of the gastric wall (T), lymph node invasion (N) and metastases (M). Conclusions. In the preoperative assessment of the invasion stage of gastric carcinoma (TNM), ultrasound endoscopy is the elective imagistic investigation for predicting the grade of invasion of the gastric wall while CT examination is a more accurate assessment of lymph node extension and metastases, the precise definition of invasion stage being only the result of histopathological examination on surgical specimens.

Corresponding author: Iancu Emil Plesea, Professor, MD, PhD, e-mail:

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