BLUE LIGHT CYSTOSCOPY IN MANAGEMENT OF NON-MUSCLE INVASIVE BLADDER CANCER
AHMED TAREK ALI ALBNHAWY;
Abstract
Bladder cancer the ninth most common cancer, it is up to three times more common in men than women. [Burger et al. 2013]. Its cardinal symptom is painless visible haematuria. [Wallace et al. 2002]. Further investigations include imaging of the upper urinary tract, urine cytology and cystoscopy, and transurethral resection of a bladder tumour(TURBT) [Kufman et al. 2009].
At presentation, 75–80 percent of patients will be diagnosed with non-muscle-invasive tumours (NMIBC: stages Ta, T1 and Tcis),with the remainder diagnosed with muscle-invasive bladder cancer (MIBC,stages T2–4) [Bryan et al. 2013].
Transurethral resection (TUR) with cystoscopy is the current main treatment for non-muscle-invasive bladder cancer (NMIBC), but residual tumour was found in 30%–70% patients after initial treatment. [Jamal et al. 2011]. Furthermore, the probability for recurrence of NMIBC at 1 and 5 years had been reported as 15%-78%, whereas the rates for progression at 1 and 5 years had been reported as <1%–45% [Sylvester et al. 2006].
Residual tumours that were undetected or overlooked during initial TUR may contribute to recurrence. WLC was considered the current standard method for detecting tumours during TUR, however, its sensitivity and specificity was not entirely satisfactory. [Madeb et al. 2007].
These residuals may be caused by inability to identify tumor and/or regrowth of residual tumor after incomplete resection. In either of these scenarios, recurrence occurs because of the clinician inability to adequately visualize the disease tissue. [Huang et al. 1991]
Recent advances in imaging modalities available for cystoscopic diagnosis and surveillance of superficial bladder cancer improve its visualization. Narrow-band imaging (NBI) provides an improved view of vasculature and superficial tissue structures of the mucosa. On NBI inspection of the bladder the aspect of a lesion is dark black against almost white normal mucosa. [Cheung et al. 2013]
Optical coherence tomography (OCT) allow performing high-resolution crosssectional imaging. OCT is analogous to ultrasound imaging, except that it uses light instead of sound. [Huang et al. 1991]. High magnification Cystoscopy allow observation of the subepithelial vascular patterns. The idea here is to differentiate classify the suspected lesions by BLC or WLC according to the vascular pattern underneath it. [Kumagi et al. 2006]
An important factor that influences the outcome of TURBT is the visibility of tumors. Blue light cystoscopy (BLC) is a new diagnostic procedure utilizing photoactive porphyrins to enhance the detection of bladder cancer. [Schmidbauer et al. 2004]
The metabolism of ALA is the first step in the biochemical pathway resulting in heme synthesis. ALA is not a photosensitizer, but rather a metabolic precursor of protoporphrin IX (PpIX), which is a photosensitizer. [Schmidbauer et al. 2004]
At presentation, 75–80 percent of patients will be diagnosed with non-muscle-invasive tumours (NMIBC: stages Ta, T1 and Tcis),with the remainder diagnosed with muscle-invasive bladder cancer (MIBC,stages T2–4) [Bryan et al. 2013].
Transurethral resection (TUR) with cystoscopy is the current main treatment for non-muscle-invasive bladder cancer (NMIBC), but residual tumour was found in 30%–70% patients after initial treatment. [Jamal et al. 2011]. Furthermore, the probability for recurrence of NMIBC at 1 and 5 years had been reported as 15%-78%, whereas the rates for progression at 1 and 5 years had been reported as <1%–45% [Sylvester et al. 2006].
Residual tumours that were undetected or overlooked during initial TUR may contribute to recurrence. WLC was considered the current standard method for detecting tumours during TUR, however, its sensitivity and specificity was not entirely satisfactory. [Madeb et al. 2007].
These residuals may be caused by inability to identify tumor and/or regrowth of residual tumor after incomplete resection. In either of these scenarios, recurrence occurs because of the clinician inability to adequately visualize the disease tissue. [Huang et al. 1991]
Recent advances in imaging modalities available for cystoscopic diagnosis and surveillance of superficial bladder cancer improve its visualization. Narrow-band imaging (NBI) provides an improved view of vasculature and superficial tissue structures of the mucosa. On NBI inspection of the bladder the aspect of a lesion is dark black against almost white normal mucosa. [Cheung et al. 2013]
Optical coherence tomography (OCT) allow performing high-resolution crosssectional imaging. OCT is analogous to ultrasound imaging, except that it uses light instead of sound. [Huang et al. 1991]. High magnification Cystoscopy allow observation of the subepithelial vascular patterns. The idea here is to differentiate classify the suspected lesions by BLC or WLC according to the vascular pattern underneath it. [Kumagi et al. 2006]
An important factor that influences the outcome of TURBT is the visibility of tumors. Blue light cystoscopy (BLC) is a new diagnostic procedure utilizing photoactive porphyrins to enhance the detection of bladder cancer. [Schmidbauer et al. 2004]
The metabolism of ALA is the first step in the biochemical pathway resulting in heme synthesis. ALA is not a photosensitizer, but rather a metabolic precursor of protoporphrin IX (PpIX), which is a photosensitizer. [Schmidbauer et al. 2004]
Other data
| Title | BLUE LIGHT CYSTOSCOPY IN MANAGEMENT OF NON-MUSCLE INVASIVE BLADDER CANCER | Other Titles | دراسة استخدام منظار المثانه ذو الضوء الأزرق فى علاج سرطان المثانه الغير غازي للعضلات | Authors | AHMED TAREK ALI ALBNHAWY | Issue Date | 2015 |
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