Is photodynamic diagnosis using hypericin better than white‐light cystoscopy for detecting superficial bladder carcinoma?

Abstract

fluorescence cystoscopy (FC) was used at the same location and the same bladder site inspected using violet light. FC findings, e.g. positive or negative red fluorescence, were documented for each specific bladder site examined, and the exact location sampled for biopsy. RESULTSThe mean ( SD , range) bladder capacity of the patients was 431 (86, 300-650) mL. In all, 179 biopsies were taken from the 41 patients; urothelial cancers were found in 41% (74) CONCLUSIONPDD using hypericin shows promise, as it has a higher sensitivity but equivalent specificity than WLC. It can be used to detect flat lesions not seen on WLC. PDD testing is also well tolerated with minimal side-effects.

Biodistribution of PVP-hypericin and hexaminolevulinate-induced PpIX in normal and orthotopic tumor-bearing rat urinary bladder

“…Presently, we cannot account for this difference, but definitely the present preclinical findings with PVP-hypericin support very well the clinical results obtained with both HSA-and PVP-hypericin that detect NMIBC with a high sensitivity and good specificity [8][9][10]28]. For example, in case of PVPhypericin used for the fluorescence-based diagnosis of bladder cancer in patients, a sensitivity ranging from 85% (dysplasia) to 100% (CIS, T1 and T2) and a specificity of 53% was found [28].…”

“…One of the compounds used is hypericin, a fluorescent photosensitizer that belongs to the chemical class of hydroxylated phenantroperylenequinones [6,7]. After intrabladder instillation in patients suspected of having bladder cancer, hypericin showed a very good sensitivity and specificity for detecting NMIBC, including carcinoma in situ (CIS) [8][9][10]. The finding that hypericin is selectively taken up by urothelial tumor cells and not by normal cells is also supported by clinical studies using fluorescence cytology [11,12].…”

Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer

“…In two 72,78 of these studies the whole patient population (n = 102) had a suspicion of bladder cancer and in three 51,58,84 the whole population had previously diagnosed bladder cancer (n = 117). The remaining eight studies 50,52,54,56,67,73,76,85 did not report this information. In total, 18 50,53,54,56,58,59,[61][62][63]67,[70][71][72][73]77,78,84,85 (67%) of 27 studies used 5-ALA as the photosensitising agent, five 57,60,65,66,81 (19%) used HAL, two 52,76 (7%) used hypericin and two 51,80 used either 5-ALA or HAL but did report the number of patients receiving each agent.…”

“…Across 20 studies 50,51,53,56,57,[59][60][61][62][63][65][66][67]70,71,76,77,80,81,84 providing information on patient age, the median (range) of means was 67 years (52-72 years). In total, 18 studies 50,53,54,57,[60][61][62][63][65][66][67]70,71,76,77,80,81,84 provided information on the gender of 2157 participants, of whom 1647 (76%) were men and 510 (24%) were women.…”

Clinical application of fluorescence endoscopic imaging using hypericin for the diagnosis of human oral cavity lesions

“…Hypericin is a plant-based photosensitiser that accumulates selectively in abnormal cells, including tumour cells (Olivo et al, 2006). We have previously shown the potential for hypericin to be used as a fluorescence contrast agent in ex vivo cytology and in in vivo fluorescence imaging for the diagnosis of bladder cancer (Olivo et al, 2003;Sim et al, 2005;Fu et al, 2007;Kah et al, 2008). We anticipate that the use of hypericin with fluorescence endoscopy can improve the sensitivity and specificity of oral cancer diagnosis compared with white light alone, by providing an enhanced contrast between the lesion and surrounding normal tissue.…”