title: Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations.
abstract: BACKGROUND
  Compared with standard white-light cystoscopy, photodynamic diagnosis with blue light and the photosensitiser hexaminolevulinate has been shown to improve the visualisation of bladder tumours, reduce residual tumour rates by at least 20%, and improve recurrence-free survival. There is currently no overall European consensus outlining specifically where hexaminolevulinate is or is not indicated.
  
  
  OBJECTIVE
  Our aim was to define specific indications for hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and management of non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  A European expert panel was convened to review the evidence for hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and management of NMIBC (identified through a PubMed MESH search) and available guidelines from across Europe. On the basis of this information and drawing on the extensive clinical experience of the panel, specific indications for the technique were then identified through discussion.
  
  
  RESULTS
  The panel recommends that hexaminolevulinate-guided fluorescence cystoscopy be used to aid diagnosis at initial transurethral resection following suspicion of bladder cancer and in patients with positive urine cytology but negative white-light cystoscopy for the assessment of tumour recurrences in patients not previously assessed with hexaminolevulinate, in the initial follow-up of patients with carcinoma in situ (CIS) or multifocal tumours, and as a teaching tool. The panel does not currently recommend the use of hexaminolevulinate-guided fluorescence cystoscopy in patients for whom cystectomy is indicated or for use in the outpatient setting with flexible cystoscopy.
  
  
  CONCLUSIONS
  Evidence is available to support the use of hexaminolevulinate-guided fluorescence cystoscopy in a range of indications, as endorsed by an expert panel.
authors.affiliation: UMC St Radboud, Netherlands, Nijmegen, The Netherlands. F.Witjes@uro.umcn.nl
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
authors.forename: Juan Palou
authors.initials: JP
authors.lastname: Redorta
authors.forename: Didier
authors.initials: D
authors.lastname: Jacqmin
authors.forename: Frank
authors.initials: F
authors.lastname: Sofras
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.forename: Claus
authors.initials: C
authors.lastname: Riedl
authors.forename: Dieter
authors.initials: D
authors.lastname: Jocham
authors.forename: Giario
authors.initials: G
authors.lastname: Conti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Harm C
authors.initials: HC
authors.lastname: Arentsen
authors.forename: Dirk
authors.initials: D
authors.lastname: Zaak
authors.forename: A Hugh
authors.initials: AH
authors.lastname: Mostafid
authors.forename: Marko
authors.initials: M
authors.lastname: Babjuk
mesh_terms: D000622:Aminolevulinic Acid / Q000031:analogs & derivatives*; D015653:Cystectomy; D003558:Cystoscopy; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D006801:Humans; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D018579:Patient Selection; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery
chemical_list: D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester