Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Department of Urology, Motol Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Eur Urol. 2014 Nov;66(5):863-71. doi: 10.1016/j.eururo.2014.06.037. Epub 2014 Jul 4.
Non-muscle-invasive bladder cancer (NMIBC) is associated with a high recurrence risk, partly because of the persistence of lesions following transurethral resection of bladder tumour (TURBT) due to the presence of multiple lesions and the difficulty in identifying the exact extent and location of tumours using standard white-light cystoscopy (WLC). Hexaminolevulinate (HAL) is an optical-imaging agent used with blue-light cystoscopy (BLC) in NMIBC diagnosis. Increasing evidence from long-term follow-up confirms the benefits of BLC over WLC in terms of increased detection and reduced recurrence rates.
To provide updated expert guidance on the optimal use of HAL-guided cystoscopy in clinical practice to improve management of patients with NMIBC, based on a review of the most recent data on clinical and cost effectiveness and expert input.
PubMed and conference searches, supplemented by personal experience.
Based on published data, it is recommended that BLC be used for all patients at initial TURBT to increase lesion detection and improve resection quality, thereby reducing recurrence and improving outcomes for patients. BLC is particularly useful in patients with abnormal urine cytology but no evidence of lesions on WLC, as it can detect carcinoma in situ that is difficult to visualise on WLC. In addition, personal experience of the authors indicates that HAL-guided BLC can be used as part of routine inpatient cystoscopic assessment following initial TURBT to confirm the efficacy of treatment and to identify any previously missed or recurrent tumours. Health economic modelling indicates that the use of HAL to assist primary TURBT is no more expensive than WLC alone and will result in improved quality-adjusted life-years and reduced costs over time.
HAL-guided BLC is a clinically effective and cost-effective tool for improving NMIBC detection and management, thereby reducing the burden of disease for patients and the health care system.
Blue-light cystoscopy (BLC) helps the urologist identify bladder tumours that may be difficult to see using standard white-light cystoscopy (WLC). As a result, the amount of tumour that is surgically removed is increased, and the risk of tumour recurrence is reduced. Although use of BLC means that the initial operation costs more than it would if only WLC were used, over time the total costs of managing bladder cancer are reduced because patients do not need as many additional operations for recurrent tumours.
非肌肉浸润性膀胱癌（NMIBC）复发风险高，部分原因是由于经尿道膀胱肿瘤切除术（TURBT）后存在多个病变，且标准白光膀胱镜检查（WLC）难以确定肿瘤的确切范围和位置，导致病变持续存在。六氨基己酸（HAL）是一种光成像剂，用于 NMIBC 诊断中的蓝激光膀胱镜检查（BLC）。来自长期随访的越来越多的证据证实，BLC 在提高检出率和降低复发率方面优于 WLC。
根据最新的临床和成本效益数据以及专家意见，为 HAL 引导的膀胱镜检查在临床实践中的最佳应用提供更新的专家指导，以改善 NMIBC 患者的管理。
在 PubMed 和会议搜索的基础上，补充个人经验。
基于已发表的数据，建议在初始 TURBT 时对所有患者使用 BLC，以提高病变检出率并提高切除质量，从而降低复发率并改善患者结局。BLC 特别适用于尿液细胞学异常但 WLC 未见病变的患者，因为它可以检测到在 WLC 上难以观察到的原位癌。此外，作者的个人经验表明，HAL 引导的 BLC 可用于初始 TURBT 后常规住院膀胱镜评估的一部分，以确认治疗效果并发现任何先前遗漏或复发的肿瘤。健康经济学模型表明，与单独使用 WLC 相比，使用 HAL 辅助初始 TURBT 的费用并不高，并且随着时间的推移，将改善质量调整生命年并降低成本。
HAL 引导的 BLC 是一种提高 NMIBC 检出率和管理水平的有效且具有成本效益的工具，从而减轻了患者和医疗保健系统的疾病负担。
蓝激光膀胱镜检查（BLC）有助于泌尿科医生识别使用标准白光膀胱镜检查（WLC）可能难以看到的膀胱肿瘤。因此，增加了手术切除的肿瘤量，降低了肿瘤复发的风险。虽然 BLC 的使用意味着初始手术费用高于仅使用 WLC 的费用，但随着时间的推移，管理膀胱癌的总成本降低，因为患者不需要因复发肿瘤而进行更多的额外手术。
