Effectiveness of hexaminolevulinate fluorescence cystoscopy for the diagnosis of non‐muscle‐invasive bladder cancer in daily clinical practice: a Spanish multicentre observational study

Palou, Juan; Hernández, Carlos; Solsona, E.; Abascal, R.; Burgués, J.P.; Rioja, Carlos Rotellar; Cabrera, J.A. Cabrera; Gutiérrez, C.; Rodríguez, Ó.; Iborra, I.; Herranz, Felipe Vilas; Abascal, José M.; Santos, G. Conde; Oliva, José Luís

doi:10.1111/bju.13020

Cited by 40 publications

(28 citation statements)

References 26 publications

(53 reference statements)

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“…Thereafter, a fluorescence cystoscopy was accurately performed and any suspicious area was reported on the same map. Biopsies were collected from any suspicious area either under blue or white light and resection of the tumors identified (TUR) [13][14][15][16].Whenever no suspicious areas could be seen, a standard random mapping including 8 biopsies overall was completed. All WLCs and BLCs were performed by the same expert urologist ( Patients with acute or chronic urinary tract infection, urinary tract lithiasis, multi-drug allergies as well as patients underwent recent BCG installation, radiotherapy and multi bladder catheterizations were excluded [12].…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Hexaminolevulinate Photodynamic Diagnosis of Non-Muscle Invasive Bladder Cancer

Papazoglou¹,

Varkarakis²,

Chrisofos³

et al. 2017

Med Surg Urol

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Objective: This study evaluated the efficacy of hexaminolevulinate fluorescence cystoscopy as a diagnostic tool for bladder cancer. The study was a case series in the Department of Urology in Hippokratio General Hospital of Athens between October 2008 and May 2012. Methods:Fifty patients (43 males and 7 females) who were investigated for hematuria were included in the study. White light cystoscopy (WLC) was first performed in all patients and after was performed a fluorescence cystoscopy (BLC-blue light cystoscopy). Biopsies were collected from any suspicious area and resection of the tumors identified (TUR).Whenever no suspicious areas could be seen, a standard random mapping including 8 biopsies overall was completed. Results:Patients demographic data and clinical history are presented in Table 1. Two-hundred twenty specimens were extracted and bladder cancer was diagnosed in 137. There were 17 CIS lesions all diagnosed with BLC whereas only 11 with WLC. WLC correctly diagnosed 109/140 specimens and the positive and negative predictive values were 77.9% and 65% respectively. The sensitivity and specificity were 79.6% and 62.6% respectively. BLC diagnosed 125/169 specimens and the positive and negative predictive values were 73.9% and 76.5% respectively. The sensitivity of BLC was 91.2% and the specificity 46.9%. Conclusion:Hexaminolevulinate-guided cystoscopy is a valuable diagnostic method, with considerably improved accuracy and improvement in diagnosis of non-muscle-invasive bladder cancer and especially CIS.

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Section: Methodsmentioning

confidence: 99%

Efficacy of Hexaminolevulinate Photodynamic Diagnosis of Non-Muscle Invasive Bladder Cancer

Papazoglou¹,

Varkarakis²,

Chrisofos³

et al. 2017

Med Surg Urol

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“…Among these 33 studies were 10 RCTs of BLC with HAL vs. WLC that were used to meta-analyze sensitivities and specificities. [13][14][15][16][17][18][19][20][21][22] Burger et al recently used raw data of RCTs to metaanalyze recurrence relative risk (RR) for BLC with HAL vs. WLC-assisted TURBT, and this RR (0.761) was used in the baseline decision-tree analysis. 23 …”

Section: Evidence Synthesismentioning

confidence: 99%

Contemporary cost-consequence analysis of blue light cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer

Klaassen¹,

Li²,

Kassouf³

et al. 2017

CUAJ

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Introduction: Previous studies have suggested cost-savings using blue light cystoscopy (BLC) with hexaminolevulinate (HAL) compared to white light cystoscopy (WLC) during transurethral resection of bladder tumour (TURBT) for non-muscle-invasive bladder cancer (NMIBC), secondary to improvements in recurrence and progression rates; however, these studies have used 'best case scenario' recurrence rate probabilities, thus decreasing generalizability of the findings. The objective of this study was to perform a contemporary cost-effectiveness assessment of BLC compared to WLC at the time of TURBT. Methods: A decision and cost-effectiveness model with a five-year time horizon following initial TURBT was used. The model was created from the healthcare payer perspective. Comprehensive literature review was performed to obtain contemporary recurrence and progression rates. These values were meta-analyzed for inclusion into the model. Cost variables included in the model were from three large Canadian bladder cancer centres. Model outputs were number of recurrences prevented, bed days saved, and overall costs. One-way sensitivity and scenario analyses were performed to assess model robustness. Results:The five-year amortized cost of using BLC with HAL on all incident NMIBC compared to WLC assistance was $4 832,908 for Ontario (n=4696; $1372/patient); $1 168 968 for British Columbia (n=1204; $1295/patient); and $2 484, 872 (n=2680; $1236/patient) for Quebec. Use of BLC with HAL would result in 87-338 fewer recurrences annually. On sensitivity/scenario analyses for Ontario data, if BLC with HAL equipment were provided to the province at no cost, five-year costs would be $4 158 814 and $1181 cost per patient. If BLC with HAL were only used for cystoscopically appearing aggressive tumours, the five-year amortized cost would be $3 874 098, with a cost per patient of $1222. If there was a 20% or 50% improvement in progression rates with BLC plus HAL, the five-year amortized cost would be $2 660 529 and -$598 039 (cost-saving), respectively. Conclusions: TURBT using BLC with HAL for patients with NMIBC is associated with a five-year cost of approximately $1-5 million for jurisdictions of 4-13 million people. Although this translates to a cost of $1200-1400 per patient for their initial TURBT, BLC with HAL improves patients care, reduces recurrences, and decreases the need for hospital beds after TURBT. If this diagnostic procedure eventually improves progression rates, there would be considerably improved cost-effectiveness.

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“…They found that LVI was associated with time to recurrence and death, while a significant benefit of adjuvant chemotherapy could not be confirmed in a small group of 27 patients with altered p53 expression and LVI. The authors concluded that, although their study did not show a survival benefit for adjuvant chemotherapy in patients with LVI, a possible benefit could not be finally excluded [1].…”

mentioning

confidence: 91%

“…The present prospective study by Palou et al [1], conducted in eight Spanish centres, documents the use of hexaminolevulinate fluorescence cystoscopy (FC)-guided bladder tumour resection and biopsies in 283 patients with non-muscle-invasive bladder cancer (NMIBC). It is an inpatient comparison between white-light cystoscopy and FC.…”

mentioning

confidence: 99%

“…The authors of this paper [1] are to be congratulated on exploring lymphovascular invasion (LVI) as a possible singular prognostic marker for time to recurrence and overall survival (OS) in a post hoc analysis of a prospective randomized study that originally explored adjuvant methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy after radical cystectomy based on p53 status. This study is the largest prospective study to date looking at the outcome of LVI in organ-confined urothelial cancer of the bladder.…”

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confidence: 99%

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Fluorescence cystoscopy: the end of biopsies for carcinoma in situ detection?

Witjes

2015

BJU International

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Effectiveness of hexaminolevulinate fluorescence cystoscopy for the diagnosis of non‐muscle‐invasive bladder cancer in daily clinical practice: a Spanish multicentre observational study

Cited by 40 publications

References 26 publications

Efficacy of Hexaminolevulinate Photodynamic Diagnosis of Non-Muscle Invasive Bladder Cancer

Efficacy of Hexaminolevulinate Photodynamic Diagnosis of Non-Muscle Invasive Bladder Cancer

Contemporary cost-consequence analysis of blue light cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer

Fluorescence cystoscopy: the end of biopsies for carcinoma in situ detection?

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