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Ladi-Seyedian SS, Ghoreifi A, Konety B, Pohar K, Holzbeierlein JM, Taylor J, Kates M, Willard B, Taylor JM, Liao JC, Kaimakliotis HZ, Porten SP, Steinberg GD, Tyson MD, Lotan Y, Daneshmand S. Racial Differences in the Detection Rate of Bladder Cancer Using Blue Light Cystoscopy: Insights from a Multicenter Registry. Cancers (Basel) 2024; 16:1268. [PMID: 38610946 PMCID: PMC11011163 DOI: 10.3390/cancers16071268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The use of blue light cystoscopy (BLC) has been shown to improve bladder tumor detection. However, data demonstrating the efficacy of BLC across different races are limited. Herein, we aim to evaluate heterogeneity in the characteristics of BLC for the detection of malignant lesions among various races. Clinicopathologic information was collected from patients enrolled in the multi-institutional Cysview® registry (2014-2021) who underwent transurethral resection or biopsy of bladder tumors. Outcome variables included sensitivity and negative and positive predictive values of BLC and white light cystoscopy (WLC) for the detection of malignant lesions among various races. Overall, 2379 separate lesions/tumors were identified from 1292 patients, of whom 1095 (85%) were Caucasian, 96 (7%) were African American, 51 (4%) were Asian, and 50 (4%) were Hispanic. The sensitivity of BLC was higher than that of WLC in the total cohort, as well as in the Caucasian and Asian subgroups. The addition of BLC to WLC increased the detection rate by 10% for any malignant lesion in the total cohort, with the greatest increase in Asian patients (18%). Additionally, the positive predictive value of BLC was highest in Asian patients (94%), while Hispanic patients had the highest negative predictive value (86%). Our study showed that regardless of race, BLC increases the detection of bladder cancer when combined with WLC.
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Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | - Alireza Ghoreifi
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | | | - Kamal Pohar
- Department of Urology, Ohio State University, Columbus, OH 43210, USA;
| | | | - John Taylor
- Department of Urology, University of Kansas, Kansas City, KS 66045, USA; (J.M.H.); (J.T.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA;
| | | | - Jennifer M. Taylor
- Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Joseph C. Liao
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA;
| | | | - Sima P. Porten
- Department of Urology, University of California San Francisco, San Francisco, CA 94115, USA;
| | - Gary D. Steinberg
- Department of Urology, Allina Health Cancer Institute, University of Minnesota, Minneapolis, MN 55407, USA;
| | - Mark D. Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA;
| | - Yair Lotan
- UT Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Siamak Daneshmand
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
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Chan K, Hampson A, Hayes J, Rabinowitz J, Vasdev N. Blue light transurethral resection and biopsy of bladder cancer with hexaminolevulinate: Histopathological characteristics and recurrence rates in a single UK centre study. BJUI Compass 2023; 4:568-574. [PMID: 37636209 PMCID: PMC10447208 DOI: 10.1002/bco2.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Blue light cystoscopy with hexaminolevulinate (HAL) during transurethral resection of bladder cancer (TURBT) has been shown to improve detection, thereby reducing bladder cancer recurrence compared with white light cystoscopy. Methods Single-centred UK (United Kingdom) study on 101 patients who underwent blue light cystoscopy between July 2017 and November 2020, performed by a single surgeon. Our study was divided into two arms; the primary arm had no prior diagnosis of bladder malignancy (N = 41), whereas secondary re-resection arm had (N = 57). Three patients with non-urothelial bladder cancer were excluded. Patients were followed up for 24 months. Data were collected on biopsy quality, histopathological characteristics and recurrence. The end points of the study were recurrence rate at 24 months in both arms and detection of CIS in patients who undergo TURBT or biopsy after initial white light study in the secondary, re-resection arm. This was analysed with Fisher's exact test. Results Of 98 patients, 39 had malignancy in their first blue light TURBT/biopsy: primary arm (10/41, 24.4%) and secondary arm (29/57, 50.9%), with detrusor present in 80.5% and 80.7%, respectively. In the secondary arm, blue light re-resection TURBT detected significantly more CIS (20.7% vs 51.7%, p = 0.0277) compared with white light with 3.4% upstaged to muscle invasive bladder cancer (G3pT2). Median time to re-resection was 3.06 months. Recurrence rate was 33.3% in the primary arm and 37.5% in the secondary arm after 24 months of follow-up. Conclusion Our data confirm that blue light TURBT with HAL provides superior detection and diagnosis of CIS in patients with previous white light cystoscopy.
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Affiliation(s)
- Kimberley Chan
- Lister HospitalEast and North Hertfordshire NHS TrustStevenageUK
| | | | - John Hayes
- Lister HospitalEast and North Hertfordshire NHS TrustStevenageUK
| | | | - Nikhil Vasdev
- Lister HospitalEast and North Hertfordshire NHS TrustStevenageUK
- School of Life and Medical SciencesUniversity of HertfordshireHatfieldUnited Kingdom
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Russo GI, Sholklapper TN, Cocci A, Broggi G, Caltabiano R, Smith AB, Lotan Y, Morgia G, Kamat AM, Witjes JA, Daneshmand S, Desai MM, Gill IS, Cacciamani GE. Performance of Narrow Band Imaging (NBI) and Photodynamic Diagnosis (PDD) Fluorescence Imaging Compared to White Light Cystoscopy (WLC) in Detecting Non-Muscle Invasive Bladder Cancer: A Systematic Review and Lesion-Level Diagnostic Meta-Analysis. Cancers (Basel) 2021; 13:4378. [PMID: 34503188 PMCID: PMC8431313 DOI: 10.3390/cancers13174378] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Despite early detection and regular surveillance of non-muscle invasive bladder cancer (NMIBC), recurrence and progression rates remain exceedingly high for this highly prevalent malignancy. Limited visualization of malignant lesions with standard cystoscopy and associated false-negative biopsy rates have been the driving force for investigating alternative and adjunctive technologies for improved cystoscopy. The aim of our systematic review and meta-analysis was to compare the sensitivity, specificity, and oncologic outcomes of photodynamic diagnosis (PDD) fluorescence, narrow band imaging (NBI), and conventional white light cystoscopy (WLC) in detecting NMIBC. Out of 1,087 studies reviewed, 17 prospective non-randomized and randomized controlled trials met inclusion criteria for the study. We demonstrated that tumor resection with either PDD and NBI exhibited lower recurrence rates and greater diagnostic sensitivity compared to WLC alone. NBI demonstrated superior disease sensitivity and specificity as compared to WLC and an overall greater hierarchical summary receiver operative characteristic. Our findings are consistent with emerging guidelines and underscore the value of integrating these enhanced technologies as a part of the standard care for patients with suspected or confirmed NMIBC.
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Affiliation(s)
- Giorgio I. Russo
- Urology Section, Department of Surgery, University of Catania, 95123 Catania, Italy;
| | - Tamir N. Sholklapper
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; (T.N.S.); (S.D.); (M.M.D.); (I.S.G.)
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, 50100 Florence, Italy;
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (R.C.)
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (R.C.)
| | - Angela B. Smith
- Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Giuseppe Morgia
- Urology Section, Department of Surgery, University of Catania, 95123 Catania, Italy;
- Department of Experimental Oncology, Mediterranean Institute of Oncology (IOM), 95029 Catania, Italy
| | - Ashish M. Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Pressler, Unit 1373, Houston, TX 77030, USA;
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; (T.N.S.); (S.D.); (M.M.D.); (I.S.G.)
| | - Mihir M. Desai
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; (T.N.S.); (S.D.); (M.M.D.); (I.S.G.)
| | - Indebir S. Gill
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; (T.N.S.); (S.D.); (M.M.D.); (I.S.G.)
| | - Giovanni E. Cacciamani
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; (T.N.S.); (S.D.); (M.M.D.); (I.S.G.)
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Kamat AM, Cookson M, Witjes JA, Stenzl A, Grossman HB. The Impact of Blue Light Cystoscopy with Hexaminolevulinate (HAL) on Progression of Bladder Cancer - A New Analysis. Bladder Cancer 2016; 2:273-278. [PMID: 27376146 PMCID: PMC4927917 DOI: 10.3233/blc-160048] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The International Bladder Cancer Group (IBCG) recently proposed a new definition of disease progression in non-muscle invasive bladder cancer (NMIBC), including change in T-stage, change to T2 or higher or change from low to high grade. Objective: To establish whether blue light cystoscopy with hexaminolevulinate (HAL) impacts the rate of progression and time to progression using the revised definition. Methods: An earlier long-term follow-up of a controlled Phase III study reported outcomes following blue light cystoscopy with HAL (255 patients) or white light (WL) cystoscopy (261 patients) in NMIBC patients. The data was re-analysed according to the new definition. Results: In the original analysis, after 4.5 years (median), eight HAL and 16 WL patients were deemed to have progressed (transition from NMIBC to muscle invasive bladder cancer, (T2-4)). According to the new definition, additional patients in both groups were found to have progressed: 31 (12.2%) HAL vs 46 (17.6%) WL (p = 0.085) with four (1.6%) HAL and 11 (4.2%) WL patients progressing from Ta to CIS. Time to progression was longer in the HAL group (p = 0.05). Conclusions: Applying the new IBCG definition there was a trend towards a lower rate of progression in HAL patients, particularly in those progressing from Ta to CIS. Time to progression was significantly prolonged. This suggests that patients should receive blue light cystoscopy with HAL rather than WL at resection. Adoption of the new definition could allow more patients at risk of progression to be treated appropriately earlier.
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Affiliation(s)
- Ashish M Kamat
- Department of Urology, University of Texas M D Anderson Cancer Center , Houston, TX, USA
| | - Michael Cookson
- Department of Urology, University of Oklahoma , Oklahoma City, OK, USA
| | - J Alfred Witjes
- Radboud University , Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Arnulf Stenzl
- Department of Urology, University Hospital , Tübingen (AS), Germany
| | - H Barton Grossman
- Department of Urology, University of Texas M D Anderson Cancer Center , Houston, TX, USA
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Calvaresi AE, Trabulsi EJ, Sonzogni M, Gomella LG, Lallas CD, Wachsmuth KS. Implementing hexaminolevulinate HCl blue light cystoscopy: a nursing perspective. AORN J 2014; 100:489-96; quiz 497-9. [PMID: 25443119 DOI: 10.1016/j.aorn.2013.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/18/2013] [Accepted: 12/07/2013] [Indexed: 10/24/2022]
Abstract
Hexaminolevulinate HCl is a diagnostic imaging agent used with blue light during cystoscopy to help detect non-muscle-invasive bladder cancer. Blue light cystoscopy performed using hexaminolevulinate HCl has been found to detect more papillary non-muscle-invasive bladder tumors than cystoscopy performed using standard white light. Because bladder instillation and retention requirements of hexaminolevulinate during cystoscopy can affect patient flow in the perioperative setting, this technique necessitates changes in nursing practice and care of patients with known or suspected non-muscle-invasive bladder cancer. Nursing personnel at one facility followed the AORN guidelines for preoperative patient care in the ambulatory setting to address staffing, preoperative nursing assessment, anesthesia evaluation, and preoperative teaching related to implementing blue light cystoscopy.
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Geavlete B, Mulţescu R, Georgescu D, Jecu M, Geavlete P. HAL fluorescence cystoscopy and TURB one year of Romanian experience. J Med Life 2009; 2:185-90. [PMID: 20108538 PMCID: PMC3018986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hexaminolevulinate blue light cystoscopy (HAL-BLC) represents an increasingly acknowledged method in bladder cancer diagnostic. We aimed to evaluate the importance of this procedure in cases of non-invasive bladder tumors (NIBT), to compare it with standard white light cystoscopy (WLC), and to establish the efficiency of blue light transurethral bladder resection (BL-TURB). Between December 2007 and December 2008, WLC and BLC were performed in 70 cases. WL-TURB was performed for all lesions visible in WL, and BL-TURB for those only detected in BL. Patients diagnosed with NIBT were followed-up after an average period of 5 months (between 18 and 22 weeks) by WLC and BLC. The control group included the same number of consecutive cases of NIBT, which underwent only WLC and WL-TURB, as well as the same follow-up protocol as the study group. WLC correctly identified 115 tumors, and BLC, 157 tumors. The detection rate was 68.8% for WLC, with a 9.4% rate of false-positive results, and 94% for BLC, with a 14.6% rate of false-positive results. The diagnostic accuracy in CIS lesions was 57.3% for WLC and 95% for BLC, while in pTa tumors; it was 68.8% for WLC and 94% for BLC. 62 cases of the study group diagnosed with NIBT emphasized a recurrence rate of 6.4% after 5 months. The control group described a recurrence rate of 24.2%. HAL fluorescence cystoscopy is a valuable diagnostic method for patients with NIBT, with considerably improved accuracy by comparison to WLC, and a significant impact upon the short-term recurrence rate.
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