Fluorescence photodetection of neoplastic urothelial lesions following intravesical instillation of 5-aminolevulinic acid
Abstract
Objectives Tiny papillary tumors and flat urothelial lesions such as dysplasia or carcinoma in situ can easily be missed during routine cystoscopy. Various methods for in vivo detection of fluorescing agents (preferentially localized in malignant tissue) have been developed. Most of them are based on systemically administered synthetic porphyrin compounds and require sensitive detection devices and image processing units for fluorescence visualization. The usefulness of intracellularly accumulated endogenous protoporphyrin IX (PPIX), induced by 5-aminolevulinic acid (ALA), for diagnosis of early bladder cancer and the correlation with cystoscopic, microscopic, and fluorescence findings was investigated. Methods ALA was instilled intravesically in 68 patients, followed by fluorescence cystoscopy with violet light from a krypton ion laser that produced fluorescence excitation. There were 299 biopsies obtained from fluorescing and nonfluorescing areas of the bladder. Results ALA-induced fluorescence could be easily observed with the naked eye during cystoscopy under violet light illumination. All tumor lesions were sharply marked with brightly shining red fluorescence. Correlation of fluorescence and microscopic findings gave a sensitivity of 100% and a specificity of 68.5%. There were 26 malignant or precancerous lesions that were missed during routine cystoscopy but were detected only by ALA-induced fluorescence. Conclusions Labeling of urothelial lesions by PPIX fluorescence induced by intravesically instilled ALA seems to be a promising diagnostic procedure for malignant lesions that are difficult to visualize with standard cystoscopy.
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In 1994, Kriegmair et al. observed bright red fluorescence in all tumor lesions after intravesical instillation of ALA in 68 patients.
“The first report showing that ALA is valuable for detecting bladder cancer came out in 1994 when Kriegmair et al. observed bright red fluorescence in all tumor lesions after intravesical instillation of ALA in 68 patients [57].”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [57]
ALA-PpIX fluorescence under blue light cystoscopy has been successfully used for the identification and removal of superficial bladder cancer.
“ALA-PpIX fluorescence under blue light cystoscopy has been successfully used for the identification and removal of superficial bladder cancer.”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [57]
ALA-induced fluorescence had 100% sensitivity and 68.5% specificity for tumor detection.
“ALA-induced fluorescence had 100% sensitivity and 68.5% specificity for tumor detection.”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [57]
Fluorescence detection under blue light illumination revealed 26 cancerous or precancerous lesions out of 299 biopsies that would have been missed by routine white light cystoscopy.
“Notably, fluorescence detection under blue light illumination revealed 26 cancerous or precancerous lesions (out of 299 biopsies) that would have been missed by the routine white light cystoscopy.”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [57]
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- Authors
- Kriegmair, M., Ehsan, A., Baumgartner, R., Lumper, W., Knuechel, R., Hofstädter, F., Steinbach, P., & Hofstetter, A.
- Affiliations
- University of Regensburg (DE)
- Venue
- Urology
- Publisher
- Elsevier BV
- Published
- 1994-12
- Volume
- 44
- Issue
- 6
- Pages
- 836-841
- ISSN
- 0090-4295 (ISSN-L)
- OpenAlex
- W2034798789
- Cited by
- 265
- References
- 19
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 7 · 2021: 6 · 2020: 6 · 2019: 10 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 11 · 2014: 4 · 2013: 10 · 2012: 8
- FWCI
- 12.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Urology (publishedVersion)
- PubMed (publishedVersion)
- University of Regensburg Publication Server (University of Regensburg) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bladder and Urothelial Cancer Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Photodynamic Therapy Research Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Porphyrin Metabolism and Disorders
- Keywords
- 5-aminolevulinic acid, fluorescence cystoscopy, protoporphyrin IX, urothelial tumors, bladder cancer, carcinoma in situ, dysplasia, intravesical instillation, early cancer detection, sensitivity and specificity
- MeSH terms
- Administration, Intravesical, Adult, Aged, Aged, 80 and over, Aminolevulinic Acid, Urinary Bladder, Urinary Bladder Neoplasms, Cystoscopy, Female, Fluorescence, Humans, Male, Middle Aged, Predictive Value of Tests, Protoporphyrins, Sensitivity and Specificity
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