Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy: an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre?

Karin Mogensen; Anders Glenthøj; Birgitte Grønkær Toft; Thomas Scheike; Gregers Gautier Hermann

doi:10.1080/21681805.2017.1353542

Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy: an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre?

Karin Mogensen, Anders Glenthøj, Birgitte Grønkær Toft, Thomas Scheike, Gregers Gautier Hermann^*

^*Corresponding author for this work

Section of Biostatistics

4 Citations (Scopus)

62 Downloads (Pure)

Abstract

Objective: The aim of this prospective open comparative study was to establish whether conventional photodynamic-guided bladder biopsies using general anaesthesia and rigid resectoscopes (inpatient) can be replaced with less traumatic flexible cystoscopy in non-sedated patients (outpatient), without compromising the diagnosis of carcinoma in situ (CIS). Materials and methods: Thirty-one patients were included. After BCG instillation for CIS, bladder biopsies were obtained using photodynamic-guided flexible cystoscopy. Two weeks later, patients underwent the conventional inpatient procedure. An external pathologist reviewed the biopsy samples. Pain and quality of life (QoL) symptom score were recorded. Results: Post-BCG biopsies showed only CIS in 10 patients; high-grade Ta or T1 tumour in three patients, who were referred for cystectomy; and normal or low-grade tumour tissue in 18 patients. There was a high agreement of identification of high-grade disease in biopsies and cytology using the two methods (κ = 0.93, 95% confidence interval 0.8–1.0). The outpatient procedure identified four high-grade patients diagnosed as ‘normal/low-grade’ in the inpatient procedure. The opposite was observed in two patients. Quality of biopsies did not differ between the two procedures. Pain scores for outpatients were low, and median QoL symptom score was significantly lower than for inpatients (24 vs 33, p = 0.02). Hospital length of stay was significantly longer for inpatients. Conclusions: Outpatient photodynamic-guided flexible cystoscopy is less traumatic than the conventional inpatient procedure in the diagnosis of CIS. It is safe and cost-effective, and may be an alternative to conventional inpatient biopsy procedures in patients with malignant urine cytology and normal white-light cystoscopy.

Original language	English
Journal	Scandinavian Journal of Urology
Volume	51
Issue number	5
Pages (from-to)	376-380
Number of pages	5
ISSN	2168-1805
DOIs	https://doi.org/10.1080/21681805.2017.1353542
Publication status	Published - 2017

Keywords

Biopsy
CIS
outpatient
photodynamic diagnosis

Access to Document

10.1080/21681805.2017.1353542Licence: CC BY-NC-ND

Outpatient photodynamic guided diagnosis of carcinoma in situ with flexible cystoscopy an alternative to conventional inpatient photodynamic guidedFinal published version, 854 KBLicence: CC BY-NC-ND

Cite this

Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy : an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre? / Mogensen, Karin; Glenthøj, Anders; Toft, Birgitte Grønkær et al.

In: Scandinavian Journal of Urology, Vol. 51, No. 5, 2017, p. 376-380.

Research output: Contribution to journal › Journal article › Research › peer-review

Mogensen, K, Glenthøj, A, Toft, BG, Scheike, T & Hermann, GG 2017, 'Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy: an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre?', Scandinavian Journal of Urology, vol. 51, no. 5, pp. 376-380. https://doi.org/10.1080/21681805.2017.1353542

@article{eabe692fd3a543dcb2a166a4e69af33b,

title = "Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy: an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre?",

abstract = "Objective: The aim of this prospective open comparative study was to establish whether conventional photodynamic-guided bladder biopsies using general anaesthesia and rigid resectoscopes (inpatient) can be replaced with less traumatic flexible cystoscopy in non-sedated patients (outpatient), without compromising the diagnosis of carcinoma in situ (CIS). Materials and methods: Thirty-one patients were included. After BCG instillation for CIS, bladder biopsies were obtained using photodynamic-guided flexible cystoscopy. Two weeks later, patients underwent the conventional inpatient procedure. An external pathologist reviewed the biopsy samples. Pain and quality of life (QoL) symptom score were recorded. Results: Post-BCG biopsies showed only CIS in 10 patients; high-grade Ta or T1 tumour in three patients, who were referred for cystectomy; and normal or low-grade tumour tissue in 18 patients. There was a high agreement of identification of high-grade disease in biopsies and cytology using the two methods (κ = 0.93, 95% confidence interval 0.8–1.0). The outpatient procedure identified four high-grade patients diagnosed as {\textquoteleft}normal/low-grade{\textquoteright} in the inpatient procedure. The opposite was observed in two patients. Quality of biopsies did not differ between the two procedures. Pain scores for outpatients were low, and median QoL symptom score was significantly lower than for inpatients (24 vs 33, p = 0.02). Hospital length of stay was significantly longer for inpatients. Conclusions: Outpatient photodynamic-guided flexible cystoscopy is less traumatic than the conventional inpatient procedure in the diagnosis of CIS. It is safe and cost-effective, and may be an alternative to conventional inpatient biopsy procedures in patients with malignant urine cytology and normal white-light cystoscopy.",

keywords = "Biopsy, CIS, outpatient, photodynamic diagnosis",

author = "Karin Mogensen and Anders Glenth{\o}j and Toft, {Birgitte Gr{\o}nk{\ae}r} and Thomas Scheike and Hermann, {Gregers Gautier}",

year = "2017",

doi = "10.1080/21681805.2017.1353542",

language = "English",

volume = "51",

pages = "376--380",

journal = "Scandinavian Journal of Urology",

issn = "2168-1805",

publisher = "Taylor & Francis",

number = "5",

}

TY - JOUR

T1 - Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy

T2 - an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre?

AU - Mogensen, Karin

AU - Glenthøj, Anders

AU - Toft, Birgitte Grønkær

AU - Scheike, Thomas

AU - Hermann, Gregers Gautier

PY - 2017

Y1 - 2017

N2 - Objective: The aim of this prospective open comparative study was to establish whether conventional photodynamic-guided bladder biopsies using general anaesthesia and rigid resectoscopes (inpatient) can be replaced with less traumatic flexible cystoscopy in non-sedated patients (outpatient), without compromising the diagnosis of carcinoma in situ (CIS). Materials and methods: Thirty-one patients were included. After BCG instillation for CIS, bladder biopsies were obtained using photodynamic-guided flexible cystoscopy. Two weeks later, patients underwent the conventional inpatient procedure. An external pathologist reviewed the biopsy samples. Pain and quality of life (QoL) symptom score were recorded. Results: Post-BCG biopsies showed only CIS in 10 patients; high-grade Ta or T1 tumour in three patients, who were referred for cystectomy; and normal or low-grade tumour tissue in 18 patients. There was a high agreement of identification of high-grade disease in biopsies and cytology using the two methods (κ = 0.93, 95% confidence interval 0.8–1.0). The outpatient procedure identified four high-grade patients diagnosed as ‘normal/low-grade’ in the inpatient procedure. The opposite was observed in two patients. Quality of biopsies did not differ between the two procedures. Pain scores for outpatients were low, and median QoL symptom score was significantly lower than for inpatients (24 vs 33, p = 0.02). Hospital length of stay was significantly longer for inpatients. Conclusions: Outpatient photodynamic-guided flexible cystoscopy is less traumatic than the conventional inpatient procedure in the diagnosis of CIS. It is safe and cost-effective, and may be an alternative to conventional inpatient biopsy procedures in patients with malignant urine cytology and normal white-light cystoscopy.

AB - Objective: The aim of this prospective open comparative study was to establish whether conventional photodynamic-guided bladder biopsies using general anaesthesia and rigid resectoscopes (inpatient) can be replaced with less traumatic flexible cystoscopy in non-sedated patients (outpatient), without compromising the diagnosis of carcinoma in situ (CIS). Materials and methods: Thirty-one patients were included. After BCG instillation for CIS, bladder biopsies were obtained using photodynamic-guided flexible cystoscopy. Two weeks later, patients underwent the conventional inpatient procedure. An external pathologist reviewed the biopsy samples. Pain and quality of life (QoL) symptom score were recorded. Results: Post-BCG biopsies showed only CIS in 10 patients; high-grade Ta or T1 tumour in three patients, who were referred for cystectomy; and normal or low-grade tumour tissue in 18 patients. There was a high agreement of identification of high-grade disease in biopsies and cytology using the two methods (κ = 0.93, 95% confidence interval 0.8–1.0). The outpatient procedure identified four high-grade patients diagnosed as ‘normal/low-grade’ in the inpatient procedure. The opposite was observed in two patients. Quality of biopsies did not differ between the two procedures. Pain scores for outpatients were low, and median QoL symptom score was significantly lower than for inpatients (24 vs 33, p = 0.02). Hospital length of stay was significantly longer for inpatients. Conclusions: Outpatient photodynamic-guided flexible cystoscopy is less traumatic than the conventional inpatient procedure in the diagnosis of CIS. It is safe and cost-effective, and may be an alternative to conventional inpatient biopsy procedures in patients with malignant urine cytology and normal white-light cystoscopy.

KW - Biopsy

KW - CIS

KW - outpatient

KW - photodynamic diagnosis

U2 - 10.1080/21681805.2017.1353542

DO - 10.1080/21681805.2017.1353542

M3 - Journal article

C2 - 28743206

AN - SCOPUS:85026244298

SN - 2168-1805

VL - 51

SP - 376

EP - 380

JO - Scandinavian Journal of Urology

JF - Scandinavian Journal of Urology

IS - 5

ER -

Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy: an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre?

Abstract

Keywords

Access to Document

Fingerprint

Cite this