DaBlaCa-11: Photodynamic Diagnosis in Flexible Cystoscopy—A Randomized Study With Focus on Recurrence

Drejer, Ditte; Moltke, A.-L.; Nielsen, Anne Ellerup; Lam, Gitte Wrist; Jensen, Jørgen Bjerggaard

doi:10.1016/j.urology.2019.12.002

Cited by 12 publications

(3 citation statements)

References 22 publications

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“…The prospective evaluation study of PDD for NMIBC surveillance noted that 33% of additional cancers were detected by PDD, and the recurrence rate of NMIBC detected and resected by PDD was lower than that by WLC [14]. This result is consistent with the findings of the recurrence-focused randomized study from Drejeret al The use of cystoscopy-based PDD for NMIBC surveillance after the first-time TURBT reduced the risk of recurrence with an OR of 0.67 (p = 0.02, 95% CI: 0.48-0.95) [15]. According to a systematic review by Veeratterapillay et al, 2288 patients from 12 randomized controlled trials were included in the meta-analysis, which found that PDD reduced recurrence rate and improved recurrence-free survival (RFS) (68.2% vs. 57.3%) for NMIBC over at least a 2-year follow-up period compared with WLC [16].…”

Section: Photodynamic Diagnosissupporting

confidence: 84%

Advances in Diagnosis and Therapy for Bladder Cancer

2022

Cancers

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Bladder cancer (BCa) is one of the most common and expensive urinary system malignancies for its high recurrence and progression rate. In recent years, immense amounts of studies have been carried out to bring a more comprehensive cognition and numerous promising clinic approaches for BCa therapy. The development of innovative enhanced cystoscopy techniques (optical techniques, imaging systems) and tumor biomarkers-based non-invasive urine screening (DNA methylation-based urine test) would dramatically improve the accuracy of tumor detection, reducing the risk of recurrence and progression of BCa. Moreover, intravesical instillation and systemic therapeutic strategies (cocktail therapy, immunotherapy, vaccine therapy, targeted therapy) also provide plentiful measures to break the predicament of BCa. Several exploratory clinical studies, including novel surgical approaches, pharmaceutical compositions, and bladder preservation techniques, emerged continually, which are supposed to be promising candidates for BCa clinical treatment. Here, recent advances and prospects of diagnosis, intravesical or systemic treatment, and novel drug delivery systems for BCa therapy are reviewed in this paper.

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Section: Photodynamic Diagnosissupporting

confidence: 84%

Advances in Diagnosis and Therapy for Bladder Cancer

2022

Cancers

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“…On the contrary, in a recent study, Drejer and colleagues highlighted the beneficial effects of flexible cystoscopy in post TURBT follow up. A reduction by 33% was noted in the short term recurrence rates over a median follow-up of eight months ( 45 ).…”

Section: Resultsmentioning

confidence: 99%

Role of Macroscopic Image Enhancement in Diagnosis of Non-Muscle-Invasive Bladder Cancer: An Analytical Review

Mulawkar

Sharma²,

Tamhankar

et al. 2022

Front. Surg.

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Early diagnosis of non-muscle-invasive bladder cancer (NMIBC) is of paramount importance to prevent morbidity and mortality due to bladder cancer. Although white light imaging (WLI) cystoscopy has long been considered the gold standard in the diagnosis of bladder cancer, it can miss lesions in a substantial percentage of patients and is very likely to miss carcinoma in situ and dysplasia. Tumor margin detection by WLI can be inaccurate. Moreover, WLI could, sometimes, be inadequate in distinguishing inflammation and malignancy. To improve the diagnostic efficacy of cystoscopy, various optical image enhancement modalities have been studied. These image enhancement modalities have been classified as macroscopic, microscopic, or molecular. Photodynamic diagnosis (PDD), narrow band imaging (NBI), and Storz image 1 S enhancement (formerly known as SPIES) are macroscopic image enhancement modalities. A relevant search was performed for literature describing macroscopic image enhancement modalities like PDD, NBI, and image 1 S enhancement. The advantages, limitations, and usefulness of each of these in the diagnosis of bladder cancer were studied. Photodynamic diagnosis requires intravesical instillation of a photosensitizing agent and a special blue light cystoscope system. PDD has been shown to be more sensitive than WLI in the detection of bladder cancer. It is superior to WLI in the detection of flat lesions. Bladder tumor resection (TURBT) by PDD results in more complete resection and reduced recurrence rates. PDD-guided TURBT may have some role in reducing the risk of progression. Narrow band imaging provides increased contrast between normal and abnormal tissues based on neovascularization, thereby augmenting WLI. NBI requires a special light source. There is no need for intravesical contrast instillation. NBI is superior to WLI in the detection of bladder cancer. The addition of NBI to WLI improves the detection of flat lesions like carcinoma in situ. NBI is not useful in predicting invasive tumors or grades of tumors. NBI-directed TURBT reduces recurrence rates and recurrence free survival. But its efficacy in retarding progression is unproven. Image 1 S-enhancement utilizes software-based image enhancement modes without the need for a special light source or intravesical contrast instillation. This system provides high-quality images and identifies additional abnormal-looking areas. Another advantage of this system is simultaneous side-by-side visualization of WLI and enhanced image, providing WLI images as the control for comparison. As with PDD, S-enhancement produces a lower rate of a missed bladder cancer diagnosis. The system significantly improves the diagnosis of NMIBC. The sensitivity and negative predictive value of image 1 S enhancement increase with the increase in cancer grade. A negative test by S-enhancement effectively rules out NMIBC. All the image enhancement modalities have proven their utility in improving detection and short-term cancer control. But none of these modalities have proven their utility in delaying progression, or in long-term cancer control. Cancer progression and long-term control are governed by the biological nature of cancer cells. Early detection by optical enhancement may not be of utility in this regard. Well-designed studies are needed to establish the efficacy of these modalities in the evaluation of patients with bladder cancer. The last word, in this regard, is yet to be written.

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“…Subsequent improvements have been made to the method to assist in diagnosis and surveillance viz. blue-light cystoscopy (photodynamic diagnosis) and narrow-band imaging (17)(18)(19)(20). Although highly operator-dependent, the overall sensitivity surpasses any other current form of diagnostic modality for the detection of UBC with sensitivity estimated at 85%, with 87% specificity (21).…”

Section: Introductionmentioning

confidence: 99%

Trends in urine biomarker discovery for urothelial bladder cancer: DNA, RNA, or protein?

Humayun-Zakaria¹,

Ward²,

Arnold³

et al. 2021

Transl Androl Urol

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Urothelial bladder cancer is a complex disease displaying a landscape of heterogenous molecular subtypes, mutation profiles and clinical presentations. Diagnosis and surveillance rely on flexible cystoscopy which has high accuracy, albeit accompanied by a high-cost burden for healthcare providers and discomfort for patients. Advances in "omic" technologies and computational biology have provided insights into the molecular pathogenesis of bladder cancer and provided powerful tools to identify markers for disease detection, risk stratification, and predicting responses to therapy. To date, numerous attempts have been made to discover and validate diagnostic biomarkers that could be deployed as an adjunct to the cystoscopic diagnosis and long-term surveillance of bladder cancer. We report a comprehensive literature analysis using PubMed to assess the changing trends in investigating DNA, RNA, or proteins as diagnostic urinary biomarkers over a period of 5 decades: 1970-2020. A gradual shift has been observed in research away from protein biomarkers to nucleic acids including different classes of RNA, and DNA methylation and mutation markers. Until 2000, publications involving protein biomarker discovery constituted 87% of the total number of research articles with DNA comprising 6% and RNA 7%. Since 2000 the proportion of protein biomarker articles has fallen to 40%, and DNA and RNA studies increased to 32% and 28%, respectively.Clearly research focus, perhaps driven by technological innovation, has shifted from proteins to nucleic acids. We optimistically hypothesise that, following thorough validation, a clinically useful detection test for bladder cancer based on a panel of DNA or RNA markers could become reality within 5-10 years.

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DaBlaCa-11: Photodynamic Diagnosis in Flexible Cystoscopy—A Randomized Study With Focus on Recurrence

Cited by 12 publications

References 22 publications

Advances in Diagnosis and Therapy for Bladder Cancer

Advances in Diagnosis and Therapy for Bladder Cancer

Role of Macroscopic Image Enhancement in Diagnosis of Non-Muscle-Invasive Bladder Cancer: An Analytical Review

Trends in urine biomarker discovery for urothelial bladder cancer: DNA, RNA, or protein?

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