Diagnostic Accuracy of Hexaminolevulinate in a Cohort of Patients Undergoing Radical Cystectomy.
To compare the accuracy of white light cystoscopy (WLC) and blue light cystoscopy (BLC) in a cohort of patients undergoing radical cystectomy (RC) for previously resected urothelial bladder cancer.



A cohort of patients undergoing RC received WLC and BLC prior radical surgery. To evaluate the residual tumor rate, the bladder was inspected after its removal and normal appearing mucosa sampled for histologic analysis. Lesions detected under WLC, BLC, or both, and biopsy samples from normal appearing mucosa, were all recorded separately.



Starting 2011, 64 patients underwent WLC and BLC prior cystectomy. Overall, 540 tissue samples were collected during cystoscopy and from normal appearing mucosa. Residual disease was found in 31/64 (48.4%) patients, including 27 (42.1%) cases of carcinoma in situ (CIS). The accuracy of BLC was much higher than WLC, both in the diagnosis of any residual disease (87.1% vs 32.3%, and 87.9% vs 51.5%, for sensitivity and specificity, respectively), as of CIS only (92.6% vs 29.6% and 83.8% vs 51.4%). We further evaluated the diagnostic accuracy as a result of the analysis on all specimens collected during the study. A total of 535 specimens were analyzed, and 58 specimens with residual disease were found, including 48 CIS foci. Again, detection rates and measures of accuracy were much better for BLC vs WLC, both overall (86.2% vs 31%, and 98.3% vs 93.3%, for sensitivity and specificity, respectively), and when CIS only was considered (89.6% vs 31.2% and 96.9% vs 92.8%).



Although BLC missed 12.9% of positive patients, and 7.4% of those with CIS, the agreement between BLC diagnostic accuracy and the definitive pathology was very robust.
1 Urology and Andrology Unit, Department of Emergency and Organ Transplantation, University Aldo Moro , Bari, Italy .
Vincenzo
V
Pagliarulo
2 Department of Urology and Mini-Invasive Surgery, Romolo Hospital , Crotone, Italy .
Stefano
S
Alba
3 Department of Biomedical Sciences and Human Oncology, University Aldo Moro , Bari, Italy .
Maria Filomena
MF
Gallone
4 Department of Surgery/Urology, Tor Vergata University , Rome, Italy .
Savino
S
Di Stasi
5 Department of Urology and Renal Transplantation, University of Foggia , Foggia, Italy .
Luigi
L
Cormio
6 Department of Epidemiology, University Hospital Campus Bio-Medico , Rome, Italy .
Tommasangelo
T
Petitti
7 Department of Urology, University Hospital Campus Bio-Medico , Rome, Italy .
Maurizio
M
Buscarini
1 Urology and Andrology Unit, Department of Emergency and Organ Transplantation, University Aldo Moro , Bari, Italy .
Paolo
P
Minafra
5 Department of Urology and Renal Transplantation, University of Foggia , Foggia, Italy .
Giuseppe
G
Carrieri
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives*; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D017319:Photosensitizing Agents; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester
Bladder cancer; carcinoma in situ; hexaminolevulinate; photodynamic diagnosis