Feasibility of Photodynamic Diagnosis for Challenging TURBt Cases Including Muscle Invasive Bladder Cancer, BCG Failure or 2nd-TUR

Background: Despite widely adopted standard methods for follow-up including cystoscopy plus cytology,recurrence rates of non muscle-invasive bladder cancer (NMIBC) have not improved over the past decades, stillranging from 60% through 70%. Hence, widely acceptable surveillance strategies with excellent sensitivity areneeded. Early recurrence has led to the development of a novel cystoscopy technique utilizing photodynamicdiagnosis (PDD). Although, no studies have evaluated the efficacy of PDD for patients of MIBC, BCG failure or2nd-transurethelial resection (TUR). Materials and
Methods: The present study was performed from October2012 through May 2013. IRB approved 25 patients initially underwent a cystoscopy examination of white lightand blue light followed by the resection of tumors identified. Resections were performed from bladder mucosaareas considered suspicious at PDD, along with PDD negative normal bladder mucosa area resected by randombiopsy. Specimens were divided into two groups, PDD positive and negative. Primary endpoints were sensitivityand specificity.
Results: A total of 147 specimens extracted from 25 patients were included in the analysis. Some45 out of 92 PDD-positive specimens were confirmed to have bladder cancer, and 51 out of PDD-negative 55specimens were confirmed to be cancer negative. The sensitivity of PDD was 91.8% (45/49) and specificity was52.0% (51/98). The sensitivity:specificity was 89.5% (17/19) : 47.6% (30/63) in 12 2nd-TUR patients, 90.5%(19/21) : 61.1% (11/18) in seven MIBC patients, and 95.0% (19/20) : 48.5% (16/33) in eight failed BCG cases.
Conclusions: PDD-TURBT has high sensitivity to diagnose BC even for 2nd-TUR, MIBC or BCG failure cases.