Diagnostic accuracy of hexaminolevulinate in a cohort of patients undergoing radical cystectomy

Purpose To compare the accuracy of white light cystoscopy (WLC) and blue light cystoscopy (BLC) in a cohort of patients undergoing radical cystectomy (RC) for previously resected urothelial bladder cancer (UCB). Patients and methods A cohort of patients undergoing RC received WLC and BLC prior radical surgery. To evaluate the residual tumor rate, the bladder was inspected after its removal and normal appearing mucosa sampled for histologic analysis. Lesions detected under WLC, BLC, or both, as well as biopsy samples from normal appearing mucosa, were all recorded separately. Results Starting 2011, 64 patients underwent WLC and BLC prior cystectomy. Overall, 540 tissue samples were collected during cystoscopy and from normal appearing mucosa. Residual disease was found in 31/64 (48.4%) patients, including 27 (42.1%) cases of CIS. The accuracy of BLC was much higher than WLC, both in the diagnosis of any residual disease (87.1% vs 32.3%, and 87.9% vs 51.5%, for sensitivity and specificity, respectively), as of CIS only (92.6% vs 29.6% and 83.8% vs 51.4%). We further evaluated the diagnostic accuracy as a result of the analysis on all specimens collected during the study. A total of 535 specimens were analyzed, and 58 specimens with residual disease were found, including 48 CIS foci. Again, detection rates and measures of accuracy were much better for BLC vs WLC, both overall (86.2% vs 31%, and 98.3% vs 93.3%, for sensitivity and specificity, respectively), and when CIS only was considered (89.6% vs 31.2% and 96.9% vs 92.8%). Conclusions Although BLC missed 12.9% of positive patients, and 7.4% of those with CIS, the agreement between BLC diagnostic accuracy and the definitive pathology was very robust.

Journal of endourology. 2017 Feb 01 [Epub ahead of print]

Vincenzo Pagliarulo, Alba Stefano, Maria Filomena Gallone, Savino Di Stasi, Luigi Cormio, Tommasangelo Petitti, Maurizio Buscarini, Paolo Minafra, Giuseppe Carrieri

University of Bari, DETO , piazza G. Cesare, 11 , Bari, Italy , 79121 ; ., Romolo Hospital, Urologia, Rocca di Neto (KR), Italy ; ., Universita degli Studi di Bari Aldo Moro, 9295, Bari, Puglia, Italy ; ., Universita degli Studi di Roma Tor Vergata, 9318, Department of Surgery/Urology, Roma, Lazio, Italy ; ., Universita degli Studi di Foggia, 18972, Department of Urology and Renal Transplantation, Foggia, Puglia, Italy ; ., ; Campus Biomedico University of Rome, Italy, Hygiene and Public Health Researcher , Via Alvaro del Portillo 21 , Rome, Italy , 00128 ; ., Campus Bio-Medico of Rome, Urology, Rome, Italy ; ., Universita degli Studi di Bari Aldo Moro, 9295, DETO, Bari, Puglia, Italy ; ., University of Foggia, Urology and Renal Transplantation, Foggia, Italy ; .

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