title: Blue light cystoscopy with hexylaminolevulinate: Our 7 years experience.
abstract: OBJECTIVE
  The objective of the present study is to evaluate the diagnostic accuracy of hexylaminolevulinate (HAL) blue light cystoscopy compared with standard white light cystoscopy (WLC) in daily practice.
  
  
  METHODS
  An observational, comparative, controlled (within patient) study was carried out at our Center. 61 consecutive patients with suspected or confirmed bladder cancer were recruited for the study from January 2008 until January 2015. Patients with suspected bladder cancer (positive cytology with negative WLC) or history of previous high-grade NMIBC or CIS were included in the study. Biopsies/resection of each positive lesion/suspicious areas were always taken after the bladder was inspected under WLC and BLC. Diagnoses of bladder tumor or CIS were considered as positive results, and the presence of normal urothelium in the biopsy specimen as negative result.
  
  
  RESULTS
  61 BLC were performed. 15/61 (24.5%) with suspected initial diagnosis of NMIBC and 46/61 (75.5%) with a history of high-risk non-muscle invasive bladder cancer (NMIBC). We performed a total of 173 biopsies/TURBT of suspicious areas: 129 positive only to the BLC and 44 both positive to WLC and BLC. 84/173 biopsies/TURBT were positive for cancer. All 84 NMIBC were positive to the BLC, while 35/84 were positive to the WLC with a sensitivity of BLC and WLC respectively of 100% and 41.7%. Sensitivity of WLC for highgrade NMIBC and CIS was 34.1% and 39% respectively while sensitivity of BLC for high-grade NMIBC and CIS was 100%. The specificity of the WLC was 79.9% compared to 48.5% of the BLC. The positive predictive value of BLC and WLC were respectively 48% (95% CI: 0.447-0.523) and 79% (95% CI: 0.856-0.734).
  
  
  CONCLUSIONS
  Our data confirm those reported in the literature: BLC increases the detection rate of NMIBC particularly in high risk patients (history of CIS or high grade). BLC is a powerful diagnostic tool in the diagnosis of bladder cancer if malignancy is suspected (positive urine cytology) and if conventional WLC is negative.
authors.affiliation: Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano. vlacetera@gmail.com.
authors.forename: Vito
authors.initials: V
authors.lastname: Lacetera
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Cantoro
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Montesi
authors.forename: Daniele
authors.initials: D
authors.lastname: Cantoro
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cervelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicetti
authors.forename: Giuliana
authors.initials: G
authors.lastname: Gabrielloni
authors.forename: Domenico
authors.initials: D
authors.lastname: Milella
authors.forename: Michele
authors.initials: M
authors.lastname: Montesi
authors.forename: Roberto
authors.initials: R
authors.lastname: Morcellini
authors.forename: Gianni
authors.initials: G
authors.lastname: Parri
authors.forename: Emilio
authors.initials: E
authors.lastname: Recanatini
authors.forename: Valerio
authors.initials: V
authors.lastname: Beatrici
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives* / Q000737:chemistry; D001706:Biopsy; D003558:Cystoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester