MP71-03 CAN PHOTODYNAMIC DIAGNOSIS-GUIDED BIOPSY REPLACE BLADDER MAPPING BIOPSY?

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP71)1 May 2024MP71-03 CAN PHOTODYNAMIC DIAGNOSIS-GUIDED BIOPSY REPLACE BLADDER MAPPING BIOPSY? Yuki Nakamura, Yudai Ishikawa, Shunya Matsumoto, Riko Ikeda, Kasumi Yoshitomi, Masaki Kobayashi, Motohiro Fujiwara, Bo Fan, Shohei Fukuda, Yuma Waseda, Hajime Tanaka, Soichiro Yoshida, and Yasuhisa Fujii Yuki NakamuraYuki Nakamura , Yudai IshikawaYudai Ishikawa , Shunya MatsumotoShunya Matsumoto , Riko IkedaRiko Ikeda , Kasumi YoshitomiKasumi Yoshitomi , Masaki KobayashiMasaki Kobayashi , Motohiro FujiwaraMotohiro Fujiwara , Bo FanBo Fan , Shohei FukudaShohei Fukuda , Yuma WasedaYuma Waseda , Hajime TanakaHajime Tanaka , Soichiro YoshidaSoichiro Yoshida , and Yasuhisa FujiiYasuhisa Fujii View All Author Informationhttps://doi.org/10.1097/01.JU.0001009548.76580.ba.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder mapping biopsies are recommended in cases of positive urine cytology or suspected carcinoma in situ (CIS) during transurethral resection of bladder tumors. Although photodynamic diagnosis (PDD) is acknowledged for its high sensitivity, whether PDD-guided biopsies can replace mapping biopsies has not been adequately evaluated. The aim of this study was to assess the diagnostic accuracy of PDD for flat or normal-looking lesions on white-light (WL) cystoscopy in bladder mapping biopsies. METHODS: Between 2018 and 2023, a total of 102 patients underwent mapping biopsies using PDD with oral 5-aminolevulinic acid. During the procedures, when a PDD-positive area was present, a specimen was collected from that area. The diagnostic accuracy of PDD-guided biopsies was assessed in 673 biopsies from flat or normal-looking lesions on WL cystoscopy, after excluding 98 elevated lesions. The sensitivity of PDD was analyzed by the locations. This study was approved by the Institutional Review Board (No. 2000-1268). RESULTS: The median age was 73 years, and 89 (87%) patients were male. The rationale for mapping biopsies was positive urine cytology in 70 patients and suspected CIS in 32 patients. Of the total lesions, cancer was identified in 110 (16%) lesions. PDD-positive areas were present in 166 (25%) lesions. Comparative analysis of PDD vs. WL findings exhibited a sensitivity of 66% vs. 46% (p<0.001), specificity of 83% vs. 89% (p<0.001), and negative predictive value (NPV) of 93% vs. 90% (p<0.001). The sensitivity of PDD findings by the location was as follows: trigone (59%), dome (73%), right (79%), left (71%), anterior (40%), posterior (100%), bladder neck (42%), and prostatic urethra (25%). Introducing mapping biopsies of the anterior wall, bladder neck and prostatic urethra in addition to the PDD-guided biopsies resulted in a significant increased sensitivity from 66% to 83% (p<0.001). In two (2.0%) patients, all the detected cancer lesions were negative for PDD. CONCLUSIONS: PDD demonstrated superior sensitivity and NPV compared to WL for flat or normal-looking lesions. Due to the low sensitivity of PDD in the anterior wall, bladder neck, and prostatic urethra, the integration of mapping biopsies at these locations, regardless of PDD findings, in addition to PDD-guided biopsies may lead to a more precise evaluation. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1161 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yuki Nakamura More articles by this author Yudai Ishikawa More articles by this author Shunya Matsumoto More articles by this author Riko Ikeda More articles by this author Kasumi Yoshitomi More articles by this author Masaki Kobayashi More articles by this author Motohiro Fujiwara More articles by this author Bo Fan More articles by this author Shohei Fukuda More articles by this author Yuma Waseda More articles by this author Hajime Tanaka More articles by this author Soichiro Yoshida More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...