High diagnostic efficacy of 5-aminolevulinic acid-induced fluorescent urine cytology for urothelial carcinoma.

In general, urine cytology is often problematic because of its low sensitivity, especially for low-grade urothelial carcinoma (UC) in clinical practice. To improve the sensitivity, we focused on 5-aminolevulinic acid (5-ALA), because recent studies suggested that 5-ALA-induced urine cytology can be used for photodynamic diagnosis. In this study, we evaluated the diagnostic efficacy of 5-ALA-induced fluorescent urine cytology for UC.

We included in this study 318 patients comprising 158 non-cancer patients, 84 bladder tumor patients, and 76 upper urinary tract urothelial carcinoma (UUT-UC) patients treated in our institution from March 2013 to September 2018. Using the same voided urine sample, we compared sensitivity and specificity between conventional urine cytology and 5-ALA-induced fluorescent urine cytology.

Overall, the sensitivity of 5-ALA-induced fluorescent urine cytology was significantly higher than that of conventional urine cytology (86.9% vs. 69.4%; p = 0.0002), and the specificity was equivalently high (96.2% vs. 95.6%; p = 1.0). In subgroup analysis, the high sensitivity of 5-ALA-induced fluorescent urine cytology was also detected regardless of age, sex, and tumor type. However, in terms of stage and grade, differences were only detected in patients with less than pTa stage (89.2% vs. 52.1%; p = 0.0001) and low-grade tumor (91.5% vs. 51.1%; p < 0.0001).

5-ALA-induced fluorescent urine cytology was significantly more effective for UC diagnosis when compared with the conventional cytology, especially in patients with low-stage and low-grade tumors. These findings indicate that 5-ALA-induced fluorescent urine cytology may potentially be a very useful tool for clinical use.

International journal of clinical oncology. 2019 Apr 11 [Epub ahead of print]

Gaku Yamamichi, Wataru Nakata, Masaru Tani, Go Tsujimura, Yuichi Tsujimoto, Mikio Nin, Akihiro Mimura, Hideaki Miwa, Masao Tsujihata

Department of Urology, Osaka Rosai Hospital, Nagasone-cho 1179-3, Kitaku, Sakaishi, Osaka, Japan., Department of Urology, Osaka Rosai Hospital, Nagasone-cho 1179-3, Kitaku, Sakaishi, Osaka, Japan. ., Department of Laboratory Medicine, Osaka Rosai Hospital, Osaka, Japan., Department of Diagnostic Pathology, Osaka Rosai Hospital, Osaka, Japan.

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