***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE We demonstrate a simple yet comprehensive method to evaluate the sensitivity of endoscopic procedures when no gold st and ard is available . MATERIAL S AND METHODS In 208 consecutive patients with superficial bladder cancer 328 endoscopies were performed to compare the sensitivity of white light and 5-aminolevulinic acid induced fluorescence endoscopy . Both procedures were performed during the same session . RESULTS The maximum interval of observable sensitivity for 5-aminolevulinic acid induced fluorescence endoscopy ranged between 78 and 97.5 % , and the best estimate for sensitivity based on realistic assumptions was 93.4 % ( 95 % confidence intervals 90 to 97.3 ) . The best sensitivity estimate for white light endoscopy was 46.7 % ( 95 % confidence intervals 39.4 to 54.3 , maximum range 47.2 to 53 % ) . CONCLUSIONS This method to determine the maximum possible range of sensitivity estimates for endoscopic procedures without a gold st and ard is easily applied . Depending on the assumptions a range of reasonable scenarios can be constructed and the corresponding sensitivities can be reported . This approach gives fast and valid results , and could further indicate the diagnostic superiority of 5-aminolevulinic acid induced fluorescence compared to white light endoscopy PURPOSE We determined whether the sensitivity of detecting dysplasia or early bladder cancer can be improved by 5-aminolevulinic acid induced porphyrin fluorescence . MATERIAL S AND METHODS A 3 % 5-aminolevulinic acid solution was instilled intravesically before  cystoscopy in 104 patients . The 5-aminolevulinic acid induced porphyrin fluorescence was excited by violet light from a krypton ion laser ( wavelength 406.7 nm . ) . RESULTS The sensitivity of the fluorescence cystoscopy ( 96.9 % ) was significantly ( p < 0.0001 ) greater than that of white light cystoscopy ( 72.7 % ) . There was no impact on specificity . CONCLUSIONS Due to the high sensitivity of the procedure fluorescence guided biopsies are recommended instead of r and om biopsies BACKGROUND Preliminary data suggest that photodiagnosis by fluorescence detection of protoporphyrin IX , a biosynthetic product of the photosensitizer 5-amino-levulinic acid ( ALA ) , is superior to conventional cystoscopy in bladder tumor detection . PATIENTS AND METHODS We instilled 1.5 g of ALA into the bladders of 52 patients with suspect bladder lesions 1 to 4 hours prior to transurethral resection or biopsy .  Red fluorescence was induced by violet-blue light ( wavelength 380 - 450 nm ) . RESULTS In 13 patients ( 25 % ) , significant tumors were detected by fluorescence that were missed on conventional cystoscopy . In the present series , ALA photodetection had a sensitivity of 94.6 % ( compared with 76 % for cystoscopy ) and a specificity of 43 % . CONCLUSION Fluorescence diagnosis with ALA may become a st and ard procedure for bladder tumor detection and resection , especially in endoscopically difficult situations ( carcinoma in situ , multifocal tumors , multiple prior resections , or previous drug instillation therapy ) PURPOSE In this European multicenter study we compared hexaminolevulinate ( HAL ) fluorescence cystoscopy and st and ard white light cystoscopy for the detection of carcinoma in situ ( CIS ) in patients suspected of having high risk bladder cancer . MATERIAL S AND METHODS This study was a prospect i ve controlled , within-patient comparison of st and ard and HAL fluorescence cystoscopy .  Eligible patients received an intravesical instillation of 50 ml HAL 8 mM solution . Cystoscopy was performed using a D light system , which provided white and blue light at 375 to 440 nm . The bladder wall was inspected and mapped , first under white light , followed by blue light . All tumors and suspicious areas identified under white light and by red fluorescence were resected or biopsied . Histological findings were assessed by an independent central pathologist blinded to the identity of the biopsies . RESULTS Of 211 evaluable patients 83 ( 39 % ) had CIS  , of whom 18 ( 22 % ) were detected by HAL cystoscopy only , 62 ( 75 % ) were detected by st and ard and HAL cystoscopy , 2 ( 2 % ) were detected by st and ard cystoscopy only and 1 ( 1 % ) was detected by nonguided biopsy . Therefore , HAL cystoscopy identified 28 % more patients with CIS than st and ard cystoscopy . The side effects of HAL instillation were negligible and no unexpected events were reported . CONCLUSIONS HAL fluorescence cystoscopy improves the detection of bladder CIS significantly , which has consequences for clinical management and may improve the patient prognosis . The procedure is easily implemented as an adjunct to st and ard cystoscopy and it adds no significant risk of complications OBJECTIVE The aim of this study was the assessment of flexible cystoscopy assisted by hexaminolevulinate ( HAL ) fluorescence . METHODS This study was a prospect i ve controlled , within-patient comparison of flexible HAL cystoscopy with st and ard flexible cystoscopy , HAL rigid and st and ard white light rigid cystoscopy .  Eligible patients received an intravesical instillation of 50 ml hexylaminolevulinate 8 mM solution . First flexible than rigid cystoscopy was performed in each patient using a Combilight PDD system ( Richard Wolf , Germany ) , which provided st and ard white light and blue light at 375 to 440 nm , with mapping of all lesions detected . All tumors and suspicious areas identified under white light and by red fluorescence with flexible or rigid cystoscopy were then resected by TUR or biopsied . The specimen was assessed by an independent blinded pathologist . RESULTS In the 45 patients studied 41 ( 91 % ) patients had exophytic tumors  , of which 39 ( 95.1 % ) were detected by HAL flexible cystoscopy and 40 ( 97.5 % ) by HAL rigid cystoscopy .  17 ( 37.8 % ) patients had  concomitant or carcinoma in situ only , which was identified by HAL flexible cystoscopy in 14 ( 82.3 % ) , by HAL rigid cystoscopy in 15 ( 88.2 % ) , by flexible st and ard in 11 ( 64.7 % ) and by st and ard white light rigid cystoscopy in 13 ( 76.7 % ) patients . CONCLUSION HAL fluorescence flexible cystoscopy compared to HAL rigid cystoscopy showed almost equivalent results in detecting papillary and flat lesions in bladder cancer patients . Both procedures were superior to st and ard white light flexible cystoscopy OBJECTIVES 1 ) To determine whether fluorescence cystoscopy after intravesical administration of 5-aminolevulinic acid ( 5-ALA ) is more sensitive in detection of dysplasia and bladder cancer when compared with conventional cystoscopy . 2 ) To determine the safety of using 5-ALA . MATERIAL S AND METHODS A 3 % 5-ALA solution was instilled intravesically before  cystoscopy in 41 patients . The 5-ALA-induced porphyrin fluorescence was excited by violet light from a xenon arc lamp ( lambda 375 - 440 mm ) . RESULTS Among the 175 biopsies obtained , the sensitivity of the fluorescence cystoscopy was greater than that of conventional cystoscopy ( 89.1 % versus 65.6 % , P < 0.05 ) . Specificity was at 64.8 % and 83.8 % respectively with P < 0.05 . Duration of ALA instillation did not seem to affect the sensitivity and specificity of photodynamic diagnosis . The procedures were well tolerated by all patients with no additional complication . CONCLUSIONS Fluorescence-guided biopsies are more sensitive than r and om biopsies in detecting dysplasia or bladder cancer without additional risk or complication . The duration of ALA instillation did not seem to affect the accuracy of photodynamic diagnosis BACKGROUND AND PURPOSE A major problem diagnosing bladder cancer using conventional white-light cystoscopy is that flat and tiny papillary neoplasms can be overlooked . Fluorescence cystoscopy is based on the detection of protoporphyrin IX (PpIX)-induced fluorescence in urothelial neoplasms through the topical administration of 5-aminolevulinic acid ( ALA ) . The diagnostic efficacy of fluorescence cystoscopy in urothelial neoplasms was evaluated in this study . The focus of this investigation was to ascertain whether fluorescence cystoscopy could make a major contribution to staging and improving the choice of adjuvant therapy after transurethral resection . PATIENTS AND METHODS A series of 62 patients with suspected bladder cancer were investigated by fluorescence cystoscopy .  An intravesical instillation of ALA was conducted 2 hours prior to fluorescence . A total of 274 tissue sample s were obtained from the fluorescing and nonfluorescing areas of the bladder . RESULTS The sensitivity and negative predictive value of  fluorescence cystoscopy  were 98.0 % and 94.7 % , respectively , but the specificity was low ( 42.9 % ) . Among a total of 148 lesions of urothelial neoplasm , 58 foci ( dysplasia in 5 , carcinoma in situ in 19 , stage Ta in 15 , T1 in 15 , above T2 in 4 ) that were invisible under white-light cystoscopy were detected by fluorescence cystoscopy . The final histopathologic status was changed in 45 % of patients ( 28/62 ) according to this technique . Among these patients , eight ( 13 % ) needed additional therapy , including a radical cystectomy in one patient and intravesical therapy in 10 . CONCLUSIONS The ALA-based fluorescence cystoscopy technique is a safe and simple procedure that enhances the detection of flat and papillary urothelial neoplasms . Moreover , it will be able to provide useful information that will enable proper staging and appropriate further treatment PURPOSE We compared hexaminolevulinate ( Hexvix ) fluorescence cystoscopy with white light cystoscopy for detecting carcinoma in situ . MATERIAL S AND METHODS In this multicenter study 298 patients with known or suspected bladder cancer underwent bladder instillation with 50 ml 8 mM hexaminolevulinate  for 1 hour  . Cystoscopy was then performed , first using st and ard white light and then hexaminolevulinate fluorescence cystoscopy . Lesions or suspicious areas identified under the 2 illumination conditions were mapped and biopsied for histological examination . In addition , 1 directed biopsy was obtained from an area appearing to be normal . RESULTS Of 196 evaluable patients 29.6 % ( 58 of 196 ) had carcinoma in situ , including 18 with carcinoma in situ alone , and 35 with carcinoma in situ and concomitant papillary disease , which was only detected on r and om biopsy in 5 . Of the 18 patients with no concomitant papillary disease carcinoma in situ was detected only by hexaminolevulinate fluorescence in 4 and only by white light in 4 . In the group with concomitant papillary disease carcinoma in situ was found only by hexaminolevulinate fluorescence in 5 patients and only by white light in 3 . The proportion of patients in whom 1 or more carcinoma in situ lesions were found only by hexaminolevulinate cystoscopy was greater than the hypothesized 5 % ( p=0.0022 ) . Overall more carcinoma in situ lesions were found by hexaminolevulinate than by white light cystoscopy in 22 of 58 patients ( 41.5 % ) , while the converse occurred in 8 of 58 ( 15.1 % ) . Biopsy results confirmed cystoscopy findings . Of a total of 113 carcinoma in situ lesions in 58 patients 104 ( 92 % ) were detected by hexaminolevulinate cystoscopy and 77 ( 68 % ) were detected by white light cystoscopy , while 5 were detected only on directed visually normal mucosal biopsy . Hexaminolevulinate instillation was well tolerated with no local or systemic side effects . CONCLUSIONS In patients with bladder cancer  hexaminolevulinate fluorescence cystoscopy with blue light can diagnose carcinoma in situ that may be missed with white light cystoscopy . Hexaminolevulinate fluorescence cystoscopy can be used in conjunction with white light cystoscopy to aid in the diagnosis of this form of bladder cancer PURPOSE We determined if improved tumor detection using hexaminolevulinate ( HAL ) fluorescence cystoscopy could lead to improved treatment in patients with bladder cancer . MATERIAL S AND METHODS A total of 146 patients with 
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The occurrence of CIS of the bladder can only be established by the pathological examination of whole bladders .
The true sensitivities of various modes of cystoscopy for detecting CIS can be revealed if patients scheduled for cystectomy are first examined with WLC , FLC , and optionally r and om biopsies .