OBJECTIVE: To assess the sensitivity and specificity of blue-light cystoscopy (BLC) with hexaminolevulinate as an adjunct to white-light cystoscopy (WLC) versus WLC alone for the detection of non-muscle-invasive bladder cancer (NMIBC), in routine clinical practice in Spain.
MATERIAL AND METHODS: An intra-patient comparative, multicentre, prospective, observational study. Adult patients with suspected or documented primary or recurrent NMIBC at eight Spanish centres were included in the study. All patients were examined with WLC followed by BLC with hexaminolevulinate. We evaluated the detection rate of bladder cancer lesions by WLC and BLC with hexaminolevulinate, overall and by tumour stage and compared with histological examination of the biopsied lesions. Sensitivity and specificity was calculated.
RESULTS: 1,569 lesions were identified from 283 patients: 621 were tumour lesions according to histology and 948 were false-positives. Of the 621 tumour lesions, 475 were detected by WLC (sensitivity 76.5%; 95% CI 73.2-79.8) and 579 were detected by BLC (sensitivity 93.2%; 95% CI 91.0-95.1; p< 0.0005). There was a significant improvement in the sensitivity in the detection of all types of NMIBC lesions with BLC compared with WLC. Of 219 patients with tumours, 188 had NMIBC (highest grade: CIS n=36; Ta n=87; T1 n=65). CIS lesions were identified more with BLC (n=27) than with WLC (n=19; sensitivity: BLC 75.0%; 95% CI 57.8-87.9 versus WLC 52.8%; 95% CI 35.5-69.6; p=0.021). Results varied across centres.
CONCLUSIONS: This study shows that improvement in diagnosis of NMIBC, mainly CIS and Ta tumours, obtained with BLC with hexaminolevulinate as an adjunct to WLC versus WLC alone can be demonstrated in routine clinical practice.
Palou J, Hernández C, Solsona E, ABascal R, Burgués J, Rioja C, Cabrera J, Gutiérrez C, Rodríguez O, Iborra I, Herranz F, Abascal J, Conde G, Oliva J. Are you the author?
Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
Reference: BJU Int. 2014 Dec 15. Epub ahead of print.