Diagnostic Accuracy of Hexaminolevulinate in a Cohort of Patients Undergoing Radical Cystectomy

J Endourol. 2017 Apr;31(4):405-411. doi: 10.1089/end.2016.0804. Epub 2017 Mar 1.


Purpose: To compare the accuracy of white light cystoscopy (WLC) and blue light cystoscopy (BLC) in a cohort of patients undergoing radical cystectomy (RC) for previously resected urothelial bladder cancer.

Patients and methods: A cohort of patients undergoing RC received WLC and BLC prior radical surgery. To evaluate the residual tumor rate, the bladder was inspected after its removal and normal appearing mucosa sampled for histologic analysis. Lesions detected under WLC, BLC, or both, and biopsy samples from normal appearing mucosa, were all recorded separately.

Results: Starting 2011, 64 patients underwent WLC and BLC prior cystectomy. Overall, 540 tissue samples were collected during cystoscopy and from normal appearing mucosa. Residual disease was found in 31/64 (48.4%) patients, including 27 (42.1%) cases of carcinoma in situ (CIS). The accuracy of BLC was much higher than WLC, both in the diagnosis of any residual disease (87.1% vs 32.3%, and 87.9% vs 51.5%, for sensitivity and specificity, respectively), as of CIS only (92.6% vs 29.6% and 83.8% vs 51.4%). We further evaluated the diagnostic accuracy as a result of the analysis on all specimens collected during the study. A total of 535 specimens were analyzed, and 58 specimens with residual disease were found, including 48 CIS foci. Again, detection rates and measures of accuracy were much better for BLC vs WLC, both overall (86.2% vs 31%, and 98.3% vs 93.3%, for sensitivity and specificity, respectively), and when CIS only was considered (89.6% vs 31.2% and 96.9% vs 92.8%).

Conclusions: Although BLC missed 12.9% of positive patients, and 7.4% of those with CIS, the agreement between BLC diagnostic accuracy and the definitive pathology was very robust.

Keywords: Bladder cancer; carcinoma in situ; hexaminolevulinate; photodynamic diagnosis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aminolevulinic Acid / analogs & derivatives*
  • Carcinoma in Situ / diagnosis
  • Carcinoma in Situ / pathology*
  • Carcinoma in Situ / surgery
  • Carcinoma, Transitional Cell / diagnosis
  • Carcinoma, Transitional Cell / pathology*
  • Carcinoma, Transitional Cell / surgery
  • Cystectomy*
  • Cystoscopy*
  • Female
  • Humans
  • Light
  • Male
  • Middle Aged
  • Neoplasm, Residual
  • Photosensitizing Agents*
  • Sensitivity and Specificity
  • Urinary Bladder Neoplasms / diagnosis
  • Urinary Bladder Neoplasms / pathology*
  • Urinary Bladder Neoplasms / surgery


  • Photosensitizing Agents
  • Aminolevulinic Acid
  • 5-aminolevulinic acid hexyl ester