A comparison of hexaminolevulinate (Hexvix) fluorescence cystoscopy and white-light cystoscopy for detection of bladder cancer: results of the HeRo observational study

Background To date, no study has presented results of photodynamic diagnosis (PDD) cystoscopy compared with white-light cystoscopy (WLC) in daily practice. The aim of the present study is to evaluate the diagnostic accuracy of hexylaminolevulinate hydrochloride (Hexvix) PDD cystoscopy compared with standardWLCused in daily practice. Methods An observational, open-label, comparative, controlled (within patient), multicenter study was carried out on 96 consecutive patients with suspected or confirmed bladder cancer. All patients had standard WLC followed by blue-light cystoscopy (BLC). Positive lesions detected using WLC and BLC were recorded. Biopsies/resection of each positive lesion were taken after the bladder was inspected. Sensitivity, specificity, positive predictive value, and negative predictive value with each method were calculated. Results Overall, 234 suspicious lesions were detected; 108 (46.2 %) were histologically confirmed to be bladder tumors/carcinoma in situ (CIS). The sensitivity of BLC biopsies was significantly higher than for WLC technique (99.1 vs 76.8 %; p\0.00001). The relative sensitivity of BLC versus WLC was 1.289, showing superiority of BLC of 28.9 %. The specificity of BLC biopsies was not significantly different compared with WLC (36.5 vs 30.2 %). Positive predictive value for BLC- and WLC-guided biopsies was 54.9 and 50.9 %, respectively. Negative predictive value per biopsy for BLC- and WLC-guided biopsies was 97.4 and 64.8 %, respectively. BLC and WLC reached the correct diagnosis in 97.9 and 88.5 % of patients, respectively. This difference was statistically significant (p = 0.0265). The lack of a random biopsy protocol was the major limitation of the study. Conclusions Hexvix PDD cystoscopy used in daily practice enhances the diagnostic accuracy of standard cystoscopy with higher negative predictive value, potentially permitting an improvement in patient prognosis.