Commentary
Comment to “Photodynamic Diagnosis With Hexaminolevulinaate in Non-Muscle-Invasive Bladder Cancer. Experience of the BLUE GROUP”
Comentario a «Diagnóstico fotodinámico con hexaminolevulinato en el cáncer vesical no músculo invasivo: experiencia del grupo B.L.U.E.»
M. Burger
Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Germany
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Burgués, G. Conde, J. Oliva, J.M. Abascal, I. Iborra, M. Puertas, F. Ordoño" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J.P." "apellidos" => "Burgués" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Conde" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Oliva" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Abascal" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Iborra" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Puertas" ] 6 => array:2 [ "nombre" => "F." "apellidos" => "Ordoño" ] 7 => array:1 [ "colaborador" => "Grupo BLUE (Blue Light Urologic Endoscopy)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480611001240" "doi" => "10.1016/j.acuro.2011.03.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611001240?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578611000606?idApp=UINPBA00004N" "url" => "/21735786/0000003500000008/v1_201304251625/S2173578611000606/v1_201304251625/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Commentary</span>" "titulo" => "Comment to “Photodynamic Diagnosis With Hexaminolevulinaate in Non-Muscle-Invasive Bladder Cancer. Experience of the BLUE GROUP”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "446" "paginaFinal" => "447" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. Burger" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Burger" "email" => array:1 [ 0 => "maximilian.burger@klinik.uni-regensburg.de" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Germany" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario a «Diagnóstico fotodinámico con hexaminolevulinato en el cáncer vesical no músculo invasivo: experiencia del grupo B.L.U.E.»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the present analysis, Burgués and the B.L.U.E. Group present data on the Hexvix<span class="elsevierStyleSup">®</span> fluorescence guided TUR.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The authors must be congratulated on their outstanding report, which transmits new and wonderful concepts about this technique. Recently, there have been many data on Hexvix supporting the value of this complement to white light. The current guideline of the European Association of Urology supports its use,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> as well as the recommendations of an international commission.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In fact, many factors suggest the extensive use of Hexvix. All the documents on Hexvix are unanimous about the best detection and reduced relapse rates; the simple bladder cancer epidemiology justifies the use of techniques that can mitigate the enormous impact of this disease on overall health, especially since the associated costs appear to reduce the global financial burden.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> However, there are, of course, many aspects to clarify.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> To what extent is the advantage of the detection the basis of the Hexvix feasibility? The B.L.U.E. Group presents a very detailed and rigorous analysis on the diagnostic accuracy of Hexvix. Certainly, I am aware of a comparable single series by the group Munich de Dirk Zaak et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> They presented data on about 4500 samples of 1700 TURs in 800 patients over 7 years of age at their center, and they conducted a photodynamic diagnosis to overcome the sensitivity of white light decisively (92% vs. 76%); 24% of the lesions were identified exclusively by photodynamic diagnosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">However, the present contribution of the B.L.U.E. Group is unique in two aspects. On the one hand, we compare three different approaches, i.e., white light versus Hexvix-assisted TUR versus random biopsies, whereas Zaak et al. compared visually identified lesions only with white light versus blue light. I have no knowledge of any comparative assessment of random sampling versus the photodynamic diagnosis in the diagnosis of CIS. Secondly, this series uses Hexvix, this is, hexaminolevulinic acid as a fluorescent dye instead of 5-aminolevulinic acid. This latter substance has never been approved for its use in the TUR and, as Burgués and the B.L.U.E. Group state in their manuscript, it has been suggested as disadvantageous compared with Hexvix due to its reduced bioavailability and its less stable pharmacodynamics. Therefore, the present series reflects the current state of the technique.</p><p id="par0015" class="elsevierStylePara elsevierViewall">What is interesting of these findings? Hexvix overall sensitivity was 94% versus 78%; as Hexvix complements white light, almost all malignant lesions are detected by photodynamic diagnosis. But they would have avoided 22 of the 600 total lesions, which were only detected by random biopsy; 20 of these lesions were CIS. While it has not been revealed how many of the lesions detected by random biopsy were concomitant to CIS in other areas of the bladder diagnosed by white light and Hexvix, it would mean that none of the patients with high-grade bladder cancer and/or CIS would have remained without such a diagnosis after Hexvix-TUR, even with the omission of the random biopsies.</p><p id="par0020" class="elsevierStylePara elsevierViewall">But what is the price of the sensitivity achieved by Hexvix? Obviously, the specificity is reduced. The B.L.U.E. Group clearly indicates that although the photodynamics is less specific than white light, the difference is not more than 9%. This finding is consistent with the broadest and potentially most representative multicenter randomized trial carried out in accordance with the FDA standards. Stenzl et al. reveal that the rate of false positives of white and blue lights does not vary significantly.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> We like it or not, our evaluation of white light is not perfectly specific either. Thus, the price of the sensitivity achieved by Hexvix seems right, as shown by Burgués and the B.L.U.E. group.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless, we still have some questions. Does that advantage have any relevant impact on the evolution of all bladder cancers? Which patients benefit decisively and should be considered for this methodology? What is the place of Hexvix in the management of long-term bladder cancer? I’m sure we’ll find out and I am even more confident that the B.L.U.E. Group will find more answers.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Burger M. Comentario a “Diagnóstico fotodinámico con hexaminolevulinato en el cáncer vesical no músculo invasivo: experiencia del grupo”. Actas Urol Esp. 2011;35:446–7.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico fotodinámico con hexaminolevulinato en el cáncer vesical no músculo invasivo: experiencia del grupo B.L.U.E" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P. Burgués" 1 => "G. Conde" 2 => "J. Oliva" 3 => "J.M. Abascal" 4 => "I. 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| 2015 August | 11 | 2 | 13 |
| 2015 July | 5 | 5 | 10 |
| 2015 June | 2 | 0 | 2 |
| 2015 May | 9 | 6 | 15 |
| 2015 April | 14 | 15 | 29 |
| 2015 March | 11 | 8 | 19 |
| 2015 February | 11 | 2 | 13 |
| 2015 January | 26 | 6 | 32 |
| 2014 December | 24 | 3 | 27 |
| 2014 November | 13 | 5 | 18 |
| 2014 October | 36 | 7 | 43 |
| 2014 September | 28 | 5 | 33 |
| 2014 August | 31 | 8 | 39 |
| 2014 July | 25 | 4 | 29 |
| 2014 June | 14 | 1 | 15 |
| 2014 May | 7 | 2 | 9 |
| 2014 April | 10 | 3 | 13 |
| 2014 March | 14 | 0 | 14 |
| 2014 February | 8 | 1 | 9 |
| 2014 January | 7 | 0 | 7 |
| 2013 December | 10 | 5 | 15 |
| 2013 November | 56 | 3 | 59 |
| 2013 October | 74 | 3 | 77 |
| 2013 September | 25 | 0 | 25 |
Show all
