Comparison between 5-aminolevulinic acid photodynamic diagnosis and narrow-band imaging for bladder cancer detection

Hiroki Hagimoto,Naofumi Tsutsumi,Masashi Kubota,Noriyuki Makita,Shiori Murata,Toshinari Yamasaki,Hidetoshi Kokubun,Yohei Abe,Yuta Mine,Mutsushi Kawakita

doi:10.1186/s12894-021-00946-w

Hiroki Hagimoto, Naofumi Tsutsumi + Show 8 more

Open Access

https://doi.org/10.1186/s12894-021-00946-w

Copy DOI

Journal: BMC Urology	Publication Date: Dec 1, 2021
Citations: 4	License type: open-access

Affiliation: Kobe City Medical Center General Hospital

Abstract

BackgroundTo compare 5-aminolevulinic acid (5-ALA)-mediated photodynamic diagnosis (PDD) with narrow-band imaging (NBI) for cancer detection during transurethral resection of bladder tumour (TURBT).MethodsBetween June 2018 and October 2020, 114 patients and 282 lesions were included in the analysis. Patients were orally administered 5-ALA (20 mg/kg) 2 h before TURBT. The bladder was inspected with white light (WL), PDD, and NBI for each patient, and all areas positive by at least one method were resected or biopsied. The imaging data were then compared to the pathology results.ResultsThe sensitivities of WL, PDD, and NBI for detecting urothelial carcinoma were 88.1%, 89.6%, and 76.2%, respectively. The specificity, positive predictive value, and negative predictive value for detecting urothelial carcinoma were 47.5%, 80.9%, and 61.3%, respectively, for WL; 22.5%, 74.5%, and 46.2%, respectively, for PDD; and 46.3%, 78.2%, and 43.5%, respectively, for NBI. PDD was significantly more sensitive than NBI for all lesions (p < 0.001) and carcinoma in situ (CIS) lesions (94.6% vs. 54.1%, p < 0.001).ConclusionsPDD can increase the detection rate of bladder cancer, compared to NBI, by greater than 10%. Therefore, 100% of CIS lesions can be detected by adding PDD to WL.

Highlights

Bladder cancer is the ninth most frequently diagnosed malignancy in the world [1] and is the fourth leading cause of death among men [2]
photodynamic diagnosis (PDD) is a technique that exploits the property of tumours or rapidly proliferating cells to emit red fluorescence during cystoscopy using blue light, after oral or intravesical administration of a photosensitizing precursor such as 5-aminolevulinic acid (5-ALA)
PDD using 5-ALA (5-ALA-PDD) for nonmuscle invasive bladder cancer reduces the risk of recurrence [12], and has a real-world sensitivity and specificity of 90.1% and 61.2%, respectively [13]

Summary

Introduction

Bladder cancer is the ninth most frequently diagnosed malignancy in the world [1] and is the fourth leading cause of death among men [2]. The 5-year recurrence rate of non-muscle-invasive bladder cancer ranges from 50 to 70%, and the reported 5-year progression rate ranges from 10 to 30% [3]. Transurethral resection of bladder tumour (TURBT) with intraoperative detection of the cancer by white light (WL) is the standard. PDD using 5-ALA (5-ALA-PDD) for nonmuscle invasive bladder cancer reduces the risk of recurrence [12], and has a real-world sensitivity and specificity of 90.1% and 61.2%, respectively [13]. For NBI, a metaanalysis showed that the pooled sensitivity and specificity for non-muscle invasive bladder cancer were 94.8% and 65.6%, respectively [14]. To compare 5-aminolevulinic acid (5-ALA)-mediated photodynamic diagnosis (PDD) with narrow-band imaging (NBI) for cancer detection during transurethral resection of bladder tumour (TURBT)

Objectives

Methods

Results

Conclusion