Prospective evaluation of fluorescence-guided cystoscopy to detect bladder cancer in a high-risk population: results from the UroScreen-Study

Abstract

ObjectiveTo prospectively evaluate the role of fluorescence-guided cystoscopy in a high-risk bladder cancer population undergoing screening based on a multi-marker panel of urine-tests (UroScreen-study).Patients and methodsUroScreen was conducted as a validation study for tumor markers within the frame of a health surveillance program of workers with occupational exposure to aromatic amines. Voluntary annual screens were done in 1,609 men. Cytology, quantitative NMP22® assay, and UroVysion (FISH) were applied to 7091 urine samples. Subjects with at least one positive urine-based tumor marker and/or persisting microscopic hematuria were offered fluorescence-guided (PDD) instead of white light cystoscopy. In case of suspicious findings histopathological evaluation by transurethral biopsy was performed. Data were statistically summarized and compared to tumors found by the standard algorithm of the screening study.ResultsTwenty-two subjects with a mean age of 58 years (39–72) underwent PDD cystoscopy. Of those 3 had positive NMP22 tests, 14 positive FISH tests and 9 suspicious cytologies. Two had persisting microscopic hematuria only. PDD cystoscopy revealed enhanced unifocal fluorescence in 14. All had subsequent transurethral biopsy or resection. In total, 1 urothelial carcinoma (pTaG1, low grade) was diagnosed. In the other participants urothelial cancer of the bladder was ruled out. Chronic cystitis was revealed in 8 of 14 biopsies. No higher detection rate was found using PDD than with the standard algorithm of the UroScreen study in which 17 tumors were detected by white light cystoscopy.ConclusionThe use of PDD does not lead to a higher cancer detection rate in a high-risk screening population. Larger sample sizes may be needed to ultimately asses the value of PDD for bladder cancer screening.

Comparison of the diagnostic performance of fluorescence in situ hybridization (FISH), nuclear matrix protein 22 (NMP22), and their combination model in bladder carcinoma detection: a systematic review and meta-analysis

“…Consequently, there were 21 studies left for full-text reading. After scrutinizing the full-text of the 21 studies, 14 studies were discarded: two did not evaluate diagnostic values of FISH or NMP22,26 one with number of controls <20,10 three were prognostic analyses,11,27,28 and eight studies did not report diagnostic performance of the combination of FISH and NMP22 12–14,29–33. Finally, seven studies were suitable for our meta-analysis 16–22…”

Optical improvements in the diagnosis of bladder cancer: implications for clinical practice

“…PDD requires preoperative intravesical application of photosensitizing agents, which will be taken up by the urothelium and incorporated into the heme-biosynthesis of the cells, resulting in an intracellular accumulation of photoactive porphyrines, especially in abnormal cells. 8,10,[16][17][18][19][20][21][22][23][24][25] After exposure to blue light (380-480 nm), the dysplastic cells emit a characteristic red fluorescence, which can be easily discriminated against the blue background of healthy urothelium ( Figure 2). 16 Two protoporphyrin analogues, 5-aminolevulinic acid (5-ALA) and its ester The efficacy of PDD with 5-ALA to increase BCa detection rates has been proven in a large number of clinical trials.…”

“…8,10,[16][17][18][19][20][21][22][23][24][25] After exposure to blue light (380-480 nm), the dysplastic cells emit a characteristic red fluorescence, which can be easily discriminated against the blue background of healthy urothelium ( Figure 2). 16 Two protoporphyrin analogues, 5-aminolevulinic acid (5-ALA) and its ester The efficacy of PDD with 5-ALA to increase BCa detection rates has been proven in a large number of clinical trials. 8,10,[16][17][18][19][20][21][22][23][24][25] Unfortunately, some of its biochemical characteristics, such as the hydrophilicity at physiological pH, low solubility in fats leading to poor bioavailability and rapid disappearance of tissue fluorescence (photobleaching) during cystoscopy, have limited the use of 5-ALA in everyday practice.…”

“…16 Two protoporphyrin analogues, 5-aminolevulinic acid (5-ALA) and its ester The efficacy of PDD with 5-ALA to increase BCa detection rates has been proven in a large number of clinical trials. 8,10,[16][17][18][19][20][21][22][23][24][25] Unfortunately, some of its biochemical characteristics, such as the hydrophilicity at physiological pH, low solubility in fats leading to poor bioavailability and rapid disappearance of tissue fluorescence (photobleaching) during cystoscopy, have limited the use of 5-ALA in everyday practice. 2 These limitations have been overcome with the introduction of HAL (Hexvix ® ), which is characterized by higher fat solubility as well as rapid and uniform absorption by urothelial cells.…”

İdrar Sitolojisi Günümüzde Mesane Kanserinin Tanı ve Takibinde Gereken Değeri Buluyor mu?

“…Sistoskopi rutin yapıldığında atlanan bazı olguların floresan ışık sistoskopisi ile yakalanabildiği de vurgulanmaktadır (34). Bu yöntemin maliyeti arttırdığı ve karşı yönde yayınlar olduğu unutulmamalıdır (35,36,37,38,39,40). İdrar sitolojisinin yeterliliğinin de değerlendiricinin deneyimine bağlı olduğu unutulmamalıdır (41,42).…”