J Cancer 2020; 11(5):1082-1093. doi:10.7150/jca.34527 This issue

Research Paper

Diagnostic accuracy of photodynamic diagnosis with 5-aminolevulinic acid, hexaminolevulinate and narrow band imaging for non-muscle invasive bladder cancer

Changhao Chen1,2*, Hao Huang1,2*, Yue Zhao3*, Hao Liu4, Yuming Luo5, Richard J. Sylvester6, Jia ping Li3, Thomas B. Lam7✉, Tianxin Lin1,2✉, Jian Huang1,2✉

1. Department of Urology,
2. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, P. R. China
3. Department of Interventional Oncology, Sun Yat-Sen University First Affiliated Hospital, Guangzhou, China;
4. Department of Urology, Chengdu Fifth People's Hospital, Chengdu, P. R. China
5. Department of Pancreatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong P. R. China
6. European Association of Urology Guidelines Office, Arnhem, The Netherlands
7. Academic Urology Unit, University of Aberdeen, Aberdeen, UK
*These authors contributed equally to this study.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Chen C, Huang H, Zhao Y, Liu H, Luo Y, Sylvester RJ, Li Jp, Lam TB, Lin T, Huang J. Diagnostic accuracy of photodynamic diagnosis with 5-aminolevulinic acid, hexaminolevulinate and narrow band imaging for non-muscle invasive bladder cancer. J Cancer 2020; 11(5):1082-1093. doi:10.7150/jca.34527. Available from https://www.jcancer.org/v11p1082.htm

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Objective: To assess the diagnostic test accuracy (DTA) of photodynamic diagnosis with 5-aminolaevulinic acid (5-ALA), hexylaminolevulinate (HAL) and narrow band imaging (NBI) for non-muscle-invasive bladder cancer (NMIBC), with white light-guided cystoscopy (WLC) as reference standard.

Materials and Methods: A systematic review and narrative synthesis was performed in accordance with PRISMA. Major electronic databases were searched until 20th May 2019. All studies assessing the DTA of 5-ALA, HAL and NBI compared with WLC at patient and lesion-level were included. Relevant sensitivity analyses and risk of bias (RoB) assessment were undertaken.

Results: 26 studies recruiting 3979 patients were eligible for inclusion. For patient-level analysis, NBI appeared to be the best (median sensitivity (SSY) 100%, median specificity (SPY) 68.45%, median positive predictive value (PPV) 90.75%, median negative predictive value (NPV) 100% and median false positive rate (FPR) 31.55%), showing better DTA outcomes than either HAL or 5-ALA. For lesion-level analysis, median SSY across NBI, HAL and 5-ALA were 93.08% (IQR 87.04-98.81%), 93.16% (IQR 91.48-97.04%) and 94.42% (IQR 82.37-95.73%) respectively. As for FPR, median values for NBI, HAL and 5-ALA were 20.40% (IQR 13.68-27.36%), 17.43% (IQR 12.79-22.40%) and 28.12% (IQR 22.08-42.39%), respectively. Sensitivity analyses based on studies with low to moderate RoB and studies with n>100 patients show similar findings.

Conclusions: NBI appears to outperform 5-ALA and HAL in terms of diagnostic accuracy. All three modalities present high FPR, hence indicating the ability to detect additional cases and lesions beyond WLC.

Keywords: non-muscle-invasive bladder cancer, diagnostic accuracy, narrow band imaging, photodynamic diagnosis, white light-guided cystoscopy