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MP38
FLUORESCENT CYSTOSCOPY WITH HEXAMINOLEVULINATE:
DIAGNOSTIC ACCURACY FOR NON MUSCLE INVASIVE BLADDER CANCER
A. Volpe, D. Giraudo, I. Zanellato, M. Billia, F. Sogni, P. Mondino, C. Terrone
Division of Urology, Maggiore della Carità Hospital, University of Oriental Piedmont, Novara, Italy
INTRODUCTION
The sensitivity of white light cystoscopy (WLC) can be improved especially for the detection of flat urothelial neoplasms. Fluorescent or blue light
cystoscopy (BLC) has the potential to overcome the limitations of WLC. Aim of this study was to compare the diagnostic accuracy of WLC and BLC in the
diagnosis of urothelial cancer and to identify the conditions where BLC can provide the highest diagnostic advantage over WLC.
PATIENTS AND METHODS
‰ 72 patients with suspicious primary or recurrent bladder tumor were enrolled. Patients who had
intravesical instillations in the 3 months before the procedure were not eligible.
‰ After intravescical instillation of Hexaminolevulinate 85 mg one hour before the procedure, the
patients underwent WLC followed by BLC. All observed lesions were reported in a diagram, biopsied or
resected.
‰ Detection rate and false detection rate of the two techniques were compared. Data were stratified
according to pathology of bladder lesions and bladder site where the lesions were observed.
‰ A subset analysis was also performed to assess the diagnostic accuracy of WLC and BLC in patients
who did (n=37) or did not (n=35) receive previous intravesical treatments.
RESULTS
‰ 269 bladder lesions were detected (99 with BLC, 8 with WLC, 162 with both techniques). 228 lesions were malignant, 41 were benign.
‰ Data on detection rate based on pathology and bladder location are reported in Table 1-2.
‰ False detection rate was 10,5% for WLC (18/170) and 13,7% for BLC (36/261).
‰ 26/72 patients (36,1%) had a diagnostic advantage with BLC (diagnosis of at least one Cis, dysplastic or papillary lesion missed at WLC).
‰ The detection rate of BLC is not decreased in patients who have undergone previous endovesical treatment (97.3% vs. 97,4%), as well as the
false detection rate is not increased (13,7% vs 13,6%).
WHITE LIGHT
CYSTOSCOPY
WHITE LIGHT
CYSTOSCOPY
BLUE LIGHT
CYSTOSCOPY
GENERAL
67,2% (154/228)
97,3% (222/228)
DYSPLASIA
65,5%
(19/29)
93,1%
(27/29)
PUN-LMP
66,1%
(45/68)
98,5%
(67/68)
LG-PUC
78,7%
(78/99)
96,9%
(96/99)
(5/5)
HG-PUC
100%
(5/5)
100%
CIS
16,6%
(4/24)
100% (24/24)
T1
100%
(3/3)
100%
Trigon
73,3%
(11/15)
Right ureteral meatus
83%
(5/6)
83%
Left ureteral meatus
85%
(6/7)
100%
(7/7)
71,8% (28/39)
97,4%
(38/39)
94,11%
Right bladder wall
(3/3)
Table 1: Detection rate based on pathology
BLUE LIGHT
CYSTOSCOPY
100%
(15/15)
(5/6)
Left bladder wall
64,7% (11/17)
Anterior wall
66,7% (16/24)
Posterior wall
75,5% (34/45)
95,5%
(43/45)
(15/17)
Dome
55,5% (35/63)
100%
(63/63)
Bladder neck
77,7%
(7/9)
100%
(9/9)
Prostatic urethra
100%
(1/1)
100%
(1/1)
100% (24/24)
Table 2. Detection rate based on location
CONCLUSIONS
BLC is a promising technique that has a significantly higher detection rate than WLC. The highest diagnostic advantage with BLC can be obtained for
the diagnosis of Cis and of lesions located at the bladder dome. The detection rate of BLC is not decreased in patients who underwent previous
endovesical treatments when the last instillation is not performed in the 3 months before the procedure.
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