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Vol. 35. Issue 8.
Pages 439-445 (September 2011)
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Vol. 35. Issue 8.
Pages 439-445 (September 2011)
Original article
DOI: 10.1016/j.acuroe.2011.03.006
Hexaminolevulinate photodynamic diagnosis in non-muscle invasive bladder cancer: Experience of the BLUE group
Diagnóstico fotodinámico con hexaminolevulinato en el cáncer vesical no músculo invasivo: experiencia del grupo BLUE
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J.P. Burguésa,??
Corresponding author
juanp.burgues@ssib.es

Corresponding author.
, G. Condeb, J. Olivac, J.M. Abascald, I. Iborrae, M. Puertasf, F. Ordoñog, Grupo BLUE (Blue Light Urologic Endoscopy)
a Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
b Servicio de Urología, Hospital Son Llàtzer, Palma de Mallorca, Spain
c Servicio de Urología, Hospital Royo Villanova, Zaragoza, Spain
d Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Spain
e Servicio de Urología, Instituto Valenciano de Oncología, Valencia, Spain
f Servicio de Urología, Hospital Marina Baixa, La Vila Joiosa, Alicante, Spain
g Servicio de Urología, Hospital Arnau de Vilanova, Valencia, Spain
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Tables (6)
Table 1. Distribution of lesions diagnosed with WL, PDD, and multiple random biopsies and PDD overdetection rate on WL.
Table 2. Distribution of the 1659 lesions according to whether they were visible or not with WL/PDD and if they corresponded to tumor/non-tumor lesions.
Table 3. Pathological anatomy of white light (WL) and blue light (PDD) false positives.
Table 4. Sensitivity of white light (WL) and blue light (PDD) stratified by stage (UICC 2002) and tumor grade (WHO 1999).
Table 5. Sensitivity and specificity of white light (WL) and blue light (PDD) and global rate of overdetection in the different series.
Table 6. Comparison of blue light sensitivity (PDD) for the diagnosis of pTa, pT1 and CIS in different series.
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Abstract
Objectives

Photodynamic diagnosis (PDD) with hexaminolevulinate has been recently used to improve detection of non-muscle invasive bladder cancer. Our main purpose was to quantify the benefit of PDD versus conventional white light cystoscopy (WL) in our area.

Materials and methods

Fluorescence-guided cystoscopy using hexaminolevulinate was performed at the time of the transurethral resection (TUR) in 305 patients from 7 Spanish hospitals. All lesions found with WL and PDD were numbered and recorded in an online database. Each lesion was sent separately for pathology analysis. Random biopsies were also obtained in 148 patients.

Results

A total of 1659 lesions were biopsied: 522 were identified with PDD and WL, 237 only with PDD, 19 only with WL and 881 random biopsies. Of the 600 tumors, PDD detected 563, WL 441 and random biopsies 29 (20 CIS). The mean overdetection rate for PDD over WL was 31.9% for all types of lesions, but it was 209% for carcinoma in situ (CIS). Sensitivity was 93.8% for PDD and 78.2% for WL. Specificity was 81.5% for PDD and 90.5% for WL. In 23% of patients, PDD detected at least one more neoplastic lesion than with WL.

Conclusions

Hexaminolevulinate fluorescence cystoscopy improves detection and resection of non-muscle invasive bladder cancer, especially of CIS. Sensitivity of PDD is higher than WL, but specificity is lower. In our study, random biopsies were able to detect some CIS not visible under PDD.

Keywords:
Photodynamic diagnosis
Hexaminolevulinate
Non-muscle invasive bladder cancer
Resumen
Objetivos

El diagnóstico fotodinámico (DFD) con hexaminolevulinato se ha empezado a utilizar recientemente para mejorar la detección del cáncer vesical no músculo invasivo. Nuestro objetivo principal fue comparar el rendimiento diagnóstico de PDD frente a endoscopia con luz blanca convencional (LB) en nuestro medio.

Material y métodos

Se realizó cistoscopia fluorescente con hexaminolevulinato en el momento de la RTU a 305 pacientes de 7 hospitales españoles. Todas las lesiones detectadas con LB y DFD fueron enumeradas y registradas en una base de datos online. Se analizó histopatológicamente cada lesión por separado. En 148 pacientes se tomaron además biopsias múltiples aleatorias (BMA).

Resultados

Se biopsiaron un total de 1.659 lesiones: 522 identificadas con DFD y LB, 237 sólo con DFD, 19 sólo con LB y 881 BMA. De 600 neoplasias diagnosticadas DPD detectó 563, LB 441 y BMA 29 (20 CIS). La tasa media de sobredetección de DPD sobre LB fue del 31,9% globalmente, pero en el caso del CIS fue del 209%. La sensibilidad de DFD fue 93,8% y la de LB 78,2%. La especificidad de DFD fue 81,5% y la de LB 90,5%. En el 23% de los pacientes se detectó al menos una lesión neoplásica más con DFD que con LB.

Conclusión

La RTU con hexaminolevulinato mejora el rendimiento diagnóstico y la calidad de la resección del cáncer vesical superficial, especialmente del CIS. La mayor sensibilidad de DFD es a costa de una menor especificidad. En nuestro estudio BMA rescató algunos falsos negativos de DPD para detectar CIS.

Palabras clave:
Diagnóstico fotodinámico
Hexaminolevulinato
Cáncer vesical no músculo invasivo

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