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A comparison of hexaminolevulinate (Hexvix®) fluorescence cystoscopy and white-light cystoscopy for detection of bladder cancer: results of the HeRo observational study

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Abstract

Background

To date, no study has presented results of photodynamic diagnosis (PDD) cystoscopy compared with white-light cystoscopy (WLC) in daily practice. The aim of the present study is to evaluate the diagnostic accuracy of hexylaminolevulinate hydrochloride (Hexvix®) PDD cystoscopy compared with standard WLC used in daily practice.

Methods

An observational, open-label, comparative, controlled (within patient), multicenter study was carried out on 96 consecutive patients with suspected or confirmed bladder cancer. All patients had standard WLC followed by blue-light cystoscopy (BLC). Positive lesions detected using WLC and BLC were recorded. Biopsies/resection of each positive lesion were taken after the bladder was inspected. Sensitivity, specificity, positive predictive value, and negative predictive value with each method were calculated.

Results

Overall, 234 suspicious lesions were detected; 108 (46.2 %) were histologically confirmed to be bladder tumors/carcinoma in situ (CIS). The sensitivity of BLC biopsies was significantly higher than for WLC technique (99.1 vs 76.8 %; p < 0.00001). The relative sensitivity of BLC versus WLC was 1.289, showing superiority of BLC of 28.9 %. The specificity of BLC biopsies was not significantly different compared with WLC (36.5 vs 30.2 %). Positive predictive value for BLC- and WLC-guided biopsies was 54.9 and 50.9 %, respectively. Negative predictive value per biopsy for BLC- and WLC-guided biopsies was 97.4 and 64.8 %, respectively. BLC and WLC reached the correct diagnosis in 97.9 and 88.5 % of patients, respectively. This difference was statistically significant (p = 0.0265). The lack of a random biopsy protocol was the major limitation of the study.

Conclusions

Hexvix® PDD cystoscopy used in daily practice enhances the diagnostic accuracy of standard cystoscopy with higher negative predictive value, potentially permitting an improvement in patient prognosis.

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Acknowledgments

GE Healthcare s.r.l. had a role in sponsoring the data and material in the study. The specific role of GE Healthcare s.r.l. is as follows: design and conduct of the study, collection of data, management of the data, and analysis and review of data.

Disclosures

The authors certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (consultantships, honoraria, stock ownership, gifts, free or reimbursed travel/vacations, equity interests, arrangements regarding patents or other vested interests, received, or pending), are the following:

Authors Alberto Lapini, Andrea Minervini, Alberto Masala, Luigi Schips, Armin Pycha, Luca Cindolo, Riccardo Giannella, Thomas Martini, Gianni Vittori, Danilo Zani, and Sergio Cosciani Cunico have nothing to declare. Author Fania Bellomo is an employee of GE Healthcare, sponsor of the study.

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Authors and Affiliations

  1. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy

    Alberto Lapini, Andrea Minervini & Gianni Vittori

  2. Unità Operativa di Urologia, A.O.R.N. “A. Cardarelli”, Napoli, Italy

    Alberto Masala & Riccardo Giannella

  3. Unità Operativa di Urologia, Azienda Sanitaria Locale Lanciano-Vasto-Chieti, Chieti, Italy

    Luigi Schips & Luca Cindolo

  4. Divisione di Urologia, Azienda Sanitaria dell’Alto Adige, Comprensorio Sanitario di Bolzano, Bolzano, Italy

    Armin Pycha & Thomas Martini

  5. GE Healthcare, Milan, Italy

    Fania Bellomo

  6. Unità Operativa di Urologia, Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Brescia, Italy

    Danilo Zani & Sergio Cosciani Cunico

  7. Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze, Villa Monna Tessa, Viale Pieraccini 18, 50139, Florence, Italy

    Andrea Minervini

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  1. Alberto Lapini
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Correspondence to Andrea Minervini.

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Lapini, A., Minervini, A., Masala, A. et al. A comparison of hexaminolevulinate (Hexvix®) fluorescence cystoscopy and white-light cystoscopy for detection of bladder cancer: results of the HeRo observational study. Surg Endosc 26, 3634–3641 (2012). https://doi.org/10.1007/s00464-012-2387-0

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  • DOI: https://doi.org/10.1007/s00464-012-2387-0

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