title: Assessment of diagnostic gain with hexaminolevulinate (HAL) in the setting of newly diagnosed non-muscle-invasive bladder cancer with positive results on urine cytology.
abstract: OBJECTIVE
  In accordance with the European Association of Urology guidelines, a second transurethral resection of the bladder (TURB) is recommended for high-grade or T1-category tumors. This practice brings into question the benefit of photodynamic diagnosis (PDD) in reducing the residual disease after TURB in patients with positive results on urine cytology showing high-grade cancer cells.
  
  
  METHODS
  A prospective, bicentric, randomized study comparing white light cystoscopy (WLC)+PDD with hexaminolevulinate arm with WLC alone (control arm) during the first TURB in patients with primary non-muscle-invasive bladder cancer and with positive results on urine cytology showing high-grade cancer cells. Patients underwent a first TURB with WLC and PDD or WLC alone, and then a second TURB with WLC and PDD, after 4 to 6 weeks. The number of tumors visualized in WLC and PDD and histology of the TURB specimen was recorded to perform a statistical analysis comparing both the 2 arms.
  
  
  RESULTS
  A total of 151 patients were enrolled (hexaminolevulinate, n = 72; control, n = 79). The number of visualized tumors did not increase with PDD in the first or second TURB. During the second TURB, the residual tumor rate was not reduced in patients who had PDD during the first TURB. No significant difference was observed regarding the pattern of category and grade, the size, and the recurrence and progression risks during either the first or the second TURB.
  
  
  CONCLUSIONS
  In the setting of primary non-muscle-invasive bladder cancer with positive results on urine cytology, performing a second TURB allows to diagnose residual tumor in approximately half of the cases. This rate was not significantly reduced by the use of the PDD during the first TURB.
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France; University of Versailles-Saint-Quentin-en-Yveline (UVSQ), Versailles, France. Electronic address: y.neuzillet@hopital-foch.org.
authors.forename: Yann
authors.initials: Y
authors.lastname: Neuzillet
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Methorst
authors.affiliation: Department of Urology, Louis Pasteur Hospital, Colmar, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France; University of Versailles-Saint-Quentin-en-Yveline (UVSQ), Versailles, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France; University of Versailles-Saint-Quentin-en-Yveline (UVSQ), Versailles, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Rouanne
authors.affiliation: Department of Pathology, Foch Hospital, Suresnes, France.
authors.forename: Camelia
authors.initials: C
authors.lastname: Radulescu
authors.affiliation: Department of Pathology, Centre Hospitalier Universitaire de Fort de France, Fort de France, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Molinie
authors.affiliation: Clinical Research Unit, Foch Hospital, Suresnes, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dreyfus
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Pelcat
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France.
authors.forename: Henry
authors.initials: H
authors.lastname: Botto
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003558:Cystoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy* / Q000652:urine*; D013520:Urologic Surgical Procedures / Q000379:methods
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester
keywords: Hexaminolevulinate; High-grade cytology; Non–muscle-invasive bladder cancer; Photodynamic diagnosis; Second TURB; Transurethral resection of bladder