Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations.
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.
Witjes
J Alfred
JA
UMC St Radboud, Netherlands, Nijmegen, The Netherlands. F.Witjes@uro.umcn.nl
Redorta
Juan Palou
JP
Jacqmin
Didier
D
Sofras
Frank
F
Malmström
Per-Uno
PU
Riedl
Claus
C
Jocham
Dieter
D
Conti
Giario
G
Montorsi
Francesco
F
Arentsen
Harm C
HC
Zaak
Dirk
D
Mostafid
A Hugh
AH
Babjuk
Marko
M
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
D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester