Comparison between 5-aminolevulinic acid photodynamic diagnosis and narrow-band imaging for bladder cancer detection

Abstract

Background To compare 5-aminolevulinic acid (5-ALA)-mediated photodynamic diagnosis (PDD) with narrow-band imaging (NBI) for cancer detection during transurethral resection of bladder tumour (TURBT). Methods Between June 2018 and October 2020, 114 patients and 282 lesions were included in the analysis. Patients were orally administered 5-ALA (20 mg/kg) 2 h before TURBT. The bladder was inspected with white light (WL), PDD, and NBI for each patient, and all areas positive by at least one method were resected or biopsied. The imaging data were then compared to the pathology results. Results The sensitivities of WL, PDD, and NBI for detecting urothelial carcinoma were 88.1%, 89.6%, and 76.2%, respectively. The specificity, positive predictive value, and negative predictive value for detecting urothelial carcinoma were 47.5%, 80.9%, and 61.3%, respectively, for WL; 22.5%, 74.5%, and 46.2%, respectively, for PDD; and 46.3%, 78.2%, and 43.5%, respectively, for NBI. PDD was significantly more sensitive than NBI for all lesions (p < 0.001) and carcinoma in situ (CIS) lesions (94.6% vs. 54.1%, p < 0.001). Conclusions PDD can increase the detection rate of bladder cancer, compared to NBI, by greater than 10%. Therefore, 100% of CIS lesions can be detected by adding PDD to WL.

Photodynamic Diagnosis and Therapy in Non-Muscle-Invasive Bladder Cancer

“…A systematic review by Chen et al indicated that NBI is a more sensitive diagnostic intervention for patients with NMIBC compared with either 5-ALA or hexylaminolevlinate (5-ALA derivative), based on diagnostic test accuracy assessment using WL cystoscopy as the reference standard [93]. However, Hagimoto et al revealed that ALA-PDD was more sensitive than NBI for CIS lesions (94.6% vs. 54.1%) [94]. Hagimoto et al reported a specificity of 22.5% for 5-ALA-PDD in BC [94].…”

“…However, Hagimoto et al revealed that ALA-PDD was more sensitive than NBI for CIS lesions (94.6% vs. 54.1%) [94]. Hagimoto et al reported a specificity of 22.5% for 5-ALA-PDD in BC [94]. However, according to Fukuhara et al, the specificity of 5-ALA in BC varies among reports, ranging from 48% to 80.6% in a review of six papers [95].…”

Transurethral resection of bladder cancer with or without fluorescence

“…Based on an older systematic review the specificity of PDD was only 63%, compared to 81% of standard white-light approach [19]. Recent retrospective cohort study from Hagimoto et al [20] compared specificity and sensitivity not only of PDD and WL TURBT but NBI approach too. In total 114 patients with 282 lesions were examined.…”

Optical spectroscopy and imaging in surgical management of cancer patients

“…PpIX fluorescence guidance (using HALA, the hexyl ester form of ALA) has been well demonstrated in clinical trials in bladder cancer, where a recent meta-analysis showed an average 11% reduced recurrence rate in nonmuscle-invasive tumors [155]: this technique is now in clinical use in Europe. HALA-PpIX florescence imaging also has superior performance to narrow band imaging for this application [156].…”