HAL fluorescence cystoscopy and TURB one year of Romanian experience

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.

Fig 1

pT1G1 urothelial bladder tumor visible both in WLC (left) and BLC (right)

Fig 2

Distinctive fluorescent aspect of a pTaG1 tumor, not visible in white light

Fig 3

pTaG1 tumor, visible in white light, with no fluorescence in blue light

Fig 4

CIS lesion, visible only in blue light

Fig 5

Suspicious flat lesion in white light, with no fluorescence in blue light and no pathological confirmation

Fig 6

CIS lesion not visible in white light but fluorescent in blue light

Fig 7

Fluorescent margin of a pT1G2 tumor after WL–TURB, confirmed by pathology

Fig 8

CIS lesion diagnosed only by blue light cystoscopy

Fig 9

CIS lesion omitted by white light

Fig 10

Suspicious lesion in white light, with no fluorescence and no pathological confirmation