Patient characteristics correlate with diagnostic performance of photodynamic diagnostic assisted transurethral resection of bladder tumors: A retrospective, single-center study

• Published in: Photodiagnosis and photodynamic therapy Vol. 46; p. 104052
• Main Authors: Suzuki, Shuhei, Nagumo, Yoshiyuki, Ikeda, Atsushi, Kojo, Kosuke, Nitta, Satoshi, Chihara, Ichiro, Shiga, Masanobu, Kawahara, Takashi, Kandori, Shuya, Hoshi, Akio, Negoro, Hiromitsu, Mathis, Bryan J., Nishiyama, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-04-2024
• Subjects: Adult; Aged; Aged, 80 and over; BCG Vaccine - therapeutic use; Bladder cancer; Clustering; Female; Humans; Male; Middle Aged; Patient characteristics; Photochemotherapy - methods; Photodynamic diagnosis; Photosensitizing Agents - therapeutic use; Retrospective Studies; Sensitivity and Specificity; Transurethral resection; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Transurethral resection; Clustering; Photodynamic diagnosis; Bladder cancer; Patient characteristics
• ISSN: 1572-1000; 1873-1597
• DOI: 10.1016/j.pdpdt.2024.104052

•Study assesses PDD-TURBT's effectiveness using oral 5-ALA based on patient data.•Cluster analysis used to identify patient subclasses for diagnostic precision.•Identified four patient subclasses with varying TURBT diagnostic performance.•Post-BCG or cytology ≥III subclasses had lower sensitivity, risking misdiagnosis.•Random biopsies in these subclasses could enhance diagnostic accuracy.
Identification of patient subclasses that correlate with the diagnostic performance of photodynamic diagnostic (PDD)-assisted transurethral resection of bladder tumors (TURBT) may improve outcomes.
Data were extracted from patients that underwent PDD-assisted TURBT at the University of Tsukuba Hospital between 2018 and 2023. Sensitivity and specificity were evaluated based on PDD findings (excluding WL findings) and pathology results. Cluster analysis using uniform manifold approximation and projection and k-means methods was performed, focusing on patients with malignant lesions.
A total of 267 patients and 2082 specimens were extracted. Sensitivity was lowest with regard to BCG treatment (53.7 %), followed by flat lesions (57.2 %), urine cytology class ≥ III (62.9 %), and recurrent tumors (64.5 %). In the cluster analysis of 231 patients with malignant lesions, two showed lower sensitivity: Cluster 3 (62.4 %), consisting of patients with recurrent tumors and post-BCG treatment, and Cluster 4 (55.7 %), consisting of patients with primary tumors and urine cytology class ≥ III. Clusters 1 and 2, consisting of patients without BCG treatment and patients with lower urine cytology classes, exhibited higher sensitivities (94.4 % and 87.7 %). Among all clusters, Cluster 4 had the highest proportion of specimens which were negative for both PDD and white light (WL) findings but actually had malignant lesions (20.8 %).
PDD-assisted TURBT sensitivity was lower in subclasses after BCG treatment or with cytology class III or higher. Random biopsy for PDD/WL double-negative lesions may improve diagnostic accuracy in these subclasses.