UMC St Radboud, Netherlands, Nijmegen, The Netherlands.
Eur Urol. 2010 Apr;57(4):607-14. doi: 10.1016/j.eururo.2010.01.025. Epub 2010 Jan 22.
Compared with standard white-light cystoscopy, photodynamic diagnosis with blue light and the photosensitiser hexaminolevulinate has been shown to improve the visualisation of bladder tumours, reduce residual tumour rates by at least 20%, and improve recurrence-free survival. There is currently no overall European consensus outlining specifically where hexaminolevulinate is or is not indicated.
Our aim was to define specific indications for hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and management of non-muscle-invasive bladder cancer (NMIBC).
A European expert panel was convened to review the evidence for hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and management of NMIBC (identified through a PubMed MESH search) and available guidelines from across Europe. On the basis of this information and drawing on the extensive clinical experience of the panel, specific indications for the technique were then identified through discussion.
The panel recommends that hexaminolevulinate-guided fluorescence cystoscopy be used to aid diagnosis at initial transurethral resection following suspicion of bladder cancer and in patients with positive urine cytology but negative white-light cystoscopy for the assessment of tumour recurrences in patients not previously assessed with hexaminolevulinate, in the initial follow-up of patients with carcinoma in situ (CIS) or multifocal tumours, and as a teaching tool. The panel does not currently recommend the use of hexaminolevulinate-guided fluorescence cystoscopy in patients for whom cystectomy is indicated or for use in the outpatient setting with flexible cystoscopy.
Evidence is available to support the use of hexaminolevulinate-guided fluorescence cystoscopy in a range of indications, as endorsed by an expert panel.
与标准白光膀胱镜相比，使用蓝光和光敏剂六亚甲基蓝进行光动力诊断已被证明可以提高膀胱肿瘤的可视化程度，将肿瘤残留率降低至少 20%，并改善无复发生存率。目前，尚无关于六亚甲基蓝的具体使用指征的总体欧洲共识。
我们的目的是为六亚甲基蓝指导下的荧光膀胱镜检查在非肌肉浸润性膀胱癌（NMIBC）的诊断和管理中的具体适应证进行定义。
召集了一个欧洲专家小组，对六亚甲基蓝指导下的荧光膀胱镜检查在 NMIBC 的诊断和管理中的证据（通过 PubMed MESH 搜索确定）以及欧洲各地的可用指南进行了审查。在此基础上，根据这些信息并借鉴专家小组的丰富临床经验，通过讨论确定了该技术的具体适应证。
专家组建议，在怀疑膀胱癌初次经尿道切除术后，在尿液细胞学检查阳性但白光膀胱镜检查阴性的情况下，用于评估先前未接受六亚甲基蓝评估的患者的肿瘤复发，在原位癌（CIS）或多灶性肿瘤的初始随访中，以及作为一种教学工具，使用六亚甲基蓝指导下的荧光膀胱镜检查。专家组目前不建议在需要行膀胱切除术的患者或在门诊行软性膀胱镜检查的患者中使用六亚甲基蓝指导下的荧光膀胱镜检查。
有证据支持在一系列适应证中使用六亚甲基蓝指导下的荧光膀胱镜检查，这得到了一个专家小组的认可。
