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.

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Citation:
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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Abstract

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