It is believed that the occurrence of relapse due to several
reasons:
known that the main method of diagnosis is endoscopic RMP.
However, conventional cystoscopy detects mainly papillary
education, and "flat" mucosal lesions (dysplasia high
degree and CIS) often go unnoticed. Identification of these entities
using a "blind" (randomly) biopsy is questionable. It is flat
lesions are a source of relapse in 30 - 75% of patients in the coming
(2-6 weeks) periods after surgery, 14 15. This proves insufficient
accuracy of standard cystoscopy (CS) and traditional radical
operations (TURP).
From the mid-90's used a new method for identifying and RMP
its recurrence - photodynamic diagnosis (PDD), based on
fluorescence of protoporphyrin IX, selectively accumulated in
tumor cells after intravesical administration of 5 - aminolevulinic
acid (5-ALA). It was established that the sensitivity of photodynamic
cystoscopy (FTSC) is 96.9% -98.7% and exceed bymorethan
20% sensitivity of CA (72.7%) 7, 12, 13. Differences in the specificity
methods were observed. 7, 12.
Materials and methods.
The results of examination and treatment of 200 patients
c suspected bladder cancer. All patients were divided into 2
group. 1 group consisted of 113 patients, endoscopic examination
(CA) and treatment (TURP) are performed without fluorescent control.
In group 2 included 87 patients in whom the complex survey
and treatment with photodynamic diagnosis.
Patients in both groups with respect to age, number and stage of tumor
bladder and the degree of malignancy. In the past, various treatment
(TUR, partial resection of the bladder, intravesical adjuvant
immuno-and chemotherapy) on the RMP in patients of group 1 was
in 91 (80.5%) patients and in 73 (83.9%) patients, 2 groups. In both groups
were included, also, the patients surveyed about the RMP for the first time:
22 (19,5%) and 14 (16,1%) patients, respectively.
all patients the second group performed DSF using 3% solution
5-ALA and light source "D-Light" firm "Karl Storz" Xenon lamp,
used in light source provides the most powerful light output
in the blue-violet range (385 - 440 nm). Procedures were carried out
by intravenous or spinal anesthesia, since identifying
fluorescent sections of mucosa should remove them.
For morphological assessment of the deleted (fluorescent) regions
mucosal biopsy using biopsy forceps and TUR biopsy
the entire depth of the bladder wall. In addition, patients whose
there was no fluorescence or diagnosed papillary tumor was carried out
additional "cold" biopsy sites are not fluorescent mucosa
from randomly selected points (the neck, side panels, rear
wall, apex and anterior wall) to identify false-negative
the results of DSF.
results of research carried out under ordinary light, were recognized
In conducting DSF results were recognized:
tour begins in the white light, and at first were removed, clearly visible
papillary tumors. Later, when the blue-violet light,
biopsy and TUR revealed fluorescent mucosal sites.
results.
in 7 (8.7%) patients, 2 groups according to the CA, DSF and "blind"
mucosal biopsy of pathological changes in the bladder were found.
Papillary formation were detected in 69 (86,2%) patients, including multifocal
growth was recorded in 26 (37,7%). Of the 69 patients of education from 0.7 to
3.5 cm in diameter on the background of unchanged mucosa detected by
CA in 50 (72.4%) patients. Additionally, in 19 (23.7%) patients with
DSF revealed a small (up to 0.5 cm) papilloma: in 17 cases against
intact mucosa, and a 2 - among the sites mucosa with nonspecific
inflammation. They hadmoreintense fluorescence compared
with the surrounding non-specifically inflamed tissue.
Only 2 patients with HPV identified in the CA is not
fluoresce with DSF (Table 1). Histological examination
Papillary formations in 61 (88.4%) patients diagnosed with transitional
Cancer Ta-T1 varying degrees of differentiation, 3 patients with transitional
invasive cancer, and T2 in 5 patients - with transitional papilloma (in
table).
Susceptibility (B) methods of diagnosis
papillary formations (CA and DSF) was carried out according to the formula: B = tase-positive
the results of the number of tase-+ number of false-positive negative
sensitivity of the CA according to our data was 72.4%,
at DSF - 96,4%. Of the 11 patients without papillary formations, 8
(72,7%) patients with standard cystoscopy revealed areas
hyperemic mucosa, regarded as nonspecific inflammation.
When DSF additional 3 patients (27,3%) patients had areas of fluorescent
mucosa, which in CA looked intact. Histological
study in 6 patients revealed nonspecific inflammation
mucosa (granular and glandulyarny cystitis), in 1 - CIS among sites
with nonspecific inflammation, and 4 patients - CIS against externally
intact mucosa.
| Research / Pathology | papillary Education (1) | Flat education (2) | Cochetanie (1) (2) |
| Diagnostics | |||
| found at CA | 50 (72,4%) | 8 (72,7%), nonspecific inflammation | 22 |
| revealed by FC (optional) | 19 (23,7%) | 3 (27,3%) | 8 |
| morphological study | |||
| Tis, Ta - T1 | 61 | 5 | 24 |
| T2 | 3 | - | 1 |
| inverted papilloma | 5 | - | 3 |
| nonspecific. inflammation | - | 6 | 2 |
| Total | 69 | 11 | 30 |
flat urothelial lesions were detected in patients
with papillary formations. When DSF CIS against the backdrop of seemingly intact
mucosa was detected inmorethan 3 timesmorefrequently than in CA and blind
biopsy. Thus, patients with the first group, CIS was detected in 10 (8.9%) patients;
and in patients with the second group - 24 patients (27,5%) patients. The most frequently
combination of flat and papillary formations were observed in patients
with recurrent bladder tumors.
Repeated endoscopy (CA and DSF)
4-6 weeks after TUR of the bladder was performed in 65 (57.6
%) Patients of group 1 and 45 (51,7%) patients, 2 groups of control
radical surgery, detection of residual tumor and exclusion
protsedivov. It should be noted that among the patients examined a
group at CA, unremoved tumors were detected in 21 (32.3%) patients
at DSF - 37 (56,9%). In a study of patients with group 2 after
standard cystoscopy detected residual tumor in 8 (17,8
%) Patients, while DSF - 13 (28,9%) patients.
Conclusions.
Analyzing the application of new diagnostic and treatment methods,
it should be noted the following benefits:
Experience of DSF and the successful treatment of patients
lets talk about the prime importance of this method in the diagnosis
and treatment of superficial forms of bladder cancer and its recurrence.
Further study of specificity and disease-free
survival for the introduction of this procedure in clinical practice
oncological institutions.
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Startsev
VY
Gorelov SI, Kagan O.F