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Photodynamic diagnosis of bladder cancer compared with white light cystoscopy: Systematic review and meta-analysis

Published online by Cambridge University Press:  25 January 2011

Graham Mowatt ,
James N'Dow ,
Luke Vale ,
Ghulam Nabi ,
Charles Boachie ,
Jonathan A. Cook ,
Cynthia Fraser  and
T. R. Leyshon Griffiths
Graham Mowatt
Affiliation:
University of Aberdeen
James N'Dow
Affiliation:
University of Aberdeen and Aberdeen Royal Infirmary
Luke Vale
Affiliation:
University of Aberdeen
Ghulam Nabi
Affiliation:
University of Dundee and Ninewells Hospital
Charles Boachie
Affiliation:
University of Aberdeen
Jonathan A. Cook
Affiliation:
University of Aberdeen
Cynthia Fraser
Affiliation:
University of Aberdeen
T. R. Leyshon Griffiths
Affiliation:
University of Leicester and Leicester General Hospital
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Abstract

Objectives: The aim of this study was to assess the test performance and clinical effectiveness of photodynamic diagnosis (PDD) compared with white light cystoscopy (WLC) in people suspected of new or recurrent bladder cancer.

Methods: A systematic review was conducted of randomized controlled trials (RCTs), nonrandomized comparative studies, or diagnostic cross-sectional studies comparing PDD with WLC. Fifteen electronic databases and Web sites were searched (last searches April 2008). For clinical effectiveness, only RCTs were considered.

Results: Twenty-seven studies (2,949 participants) assessed test performance. PDD had higher sensitivity than WLC (92 percent, 95 percent confidence interval [CI], 80–100 percent versus 71 percent, 95 percent CI, 49–93 percent) but lower specificity (57 percent, 95 percent CI, 36–79 percent versus 72 percent, 95 percent CI, 47–96 percent). For detecting higher risk tumors, median range sensitivity of PDD (89 percent [6–100 percent]) was higher than WLC (56 percent [0–100 percent]) whereas for lower risk tumors it was broadly similar (92 percent [20–95 percent] versus 95 percent [8–100 percent]). Four RCTs (709 participants) using 5-aminolaevulinic acid (5-ALA) as the photosensitising agent reported clinical effectiveness. Using PDD at transurethral resection of bladder tumor (TURBT) resulted in fewer residual tumors at check cystoscopy (relative risk [RR], 0.37, 95 percent CI, 0.20–0.69) and longer recurrence-free survival (RR, 1.37, 95 percent CI, 1.18–1.59), compared with WLC.

Conclusions: PDD detects more bladder tumors than WLC, including more high-risk tumors. Based on four RCTs reporting clinical effectiveness, 5-aminolaevulinic acid–mediated PDD at TURBT facilitates a more complete resection and prolongs recurrence-free survival.

Keywords

Systematic reviewMeta-analysisDiagnostic testsBladder cancer
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 27 , Issue 1 , January 2011 , pp. 3 - 10
Copyright
Copyright © Cambridge University Press 2011

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References

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