Urology>>>>>Bladder Cancer
Question 5#

Which of the following statements is FALSE regarding fluorescence-guided biopsy or photodynamic diagnosis (PDD) and resection?

a. The value of fluorescence cystoscopy for improvement of the outcome in relation to progression rate or survival has not been proven
b. The additional detection rate with PDD for all tumours is about 35% and about 40% for CIS
c. False positivity can occur due to recent TUR and during the first three months after BCG instillation
d. A large, multicentre, RCT comparing hexa-aminolaevulinic acid (HAL) fluorescence guided TUR with standard TUR reported an absolute reduction of no more than 9% in the recurrence rate within 9 months in the HAL arm

Correct Answer is B

Comment:

Answer B

Photodynamic diagnosis (PDD) is performed using filtered blue light after intravesical instillation of a photosensitiser 5-Aminolaevulinic acid (ALA) or hexa-aminolaevulinic acid (HAL). The additional detection rate with PDD for all tumours is about 20% and about 23% for CIS.

The EAU guidelines recommend that if the equipment is available, fluorescence guided (PDD) biopsy should be performed when bladder CIS is suspected (e.g., positive urine cytology, recurrent tumour with previous history of a high-grade lesion). 

Further Reading;

Kausch I, Sommerauer M, Montorsi F, et al. Photodynamic diagnosis in non-muscle-invasive bladder cancer: A systematic review and cumulative analysis of prospective studies. Eur Urol 2010; 57(4): 595–606.