HAL fluorescence cystoscopy and TURB.One year of Romanian experience

Hexaminolevulinate blue light cystoscopy (HAL–BLC) represents an increasingly acknowledged method in bladder cancer diagnostic. We aimed to evaluate the importance of this procedure in cases of non–invasive bladder tumors (NIBT), to compare it with standard white light cystoscopy (WLC), and to establish the efficiency of blue light transurethral bladder resection (BL–TURB). Between December 2007 and December 2008, WLC and BLC were performed in 70 cases. WL–TURB was performed for all lesions visible in WL, and BL–TURB for those only detected in BL. Patients diagnosed with NIBT were followed–up after an average period of 5 months (between 18 and 22 weeks) by WLC and BLC. The control group included the same number of consecutive cases of NIBT, which underwent only WLC and WL–TURB, as well as the same follow–up protocol as the study group. WLC correctly identified 115 tumors, and BLC, 157 tumors. The detection rate was 68.8% for WLC, with a 9.4% rate of false–positive results, and 94% for BLC, with a 14.6% rate of false–positive results. The diagnostic accuracy in CIS lesions was 57.3% for WLC and 95% for BLC, while in pTa tumors; it was 68.8% for WLC and 94% for BLC. 62 cases of the study group diagnosed with NIBT emphasized a recurrence rate of 6.4% after 5 months. The control group described a recurrence rate of 24.2%. HAL fluorescence cystoscopy is a valuable diagnostic method for patients with NIBT, with considerably improved accuracy by comparison to WLC, and a significant impact upon the short–term recurrence rate.