Ja, det er en grunn til at AUA guidelines så har NBI klassifisering C og «may be used», mens Cysview og BLC har klassifisering B og «should be used», samt at Cysview og BLC har refusjon mens NBI ikke har det.
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Om jeg har forstått det riktig så ser man kort sagt bedre kreften med NBI, mens med BLCC så ser man mer kreft(og bedre)?
I forhold til vanlig hvitt lys.
Med NBI ser man blodårene mer tydelig, ikke kreftcellene. I noen svulster vil blodårene være mer fremtredende og dermed korrelere med kreft, men dette er ikke alltid tilfelle.
Det er mer effektivt å fremheve kreftcellene(Cysview) enn blodårene(NBI).
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hvor stor markedsandel har Olympus med NBI i US?
Hvor mange scope har de utplassert?
La til et par linker over.
Jeg må si at for mitt øye ser jo Cysview ut som en ren nobrainer ift det der.
Ref pasientforumet:
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Det er helt klart en pågående prosess. Denne tar tid, men BLCC teknologien er uomtvistelig best. Men her dreier det seg også om holdninger, penger, tid og ressurser. Trolig også bindinger til andre aktører. Men kampen er startet og BLCC vinner terreng. Denne prosessen vil gå raskere og raskere men vi må belage oss på at ting vil ta lengre tid enn vi gjerne skulle ønske. Men den som venter på noe godt venter ikke forgjeves.
Ja, først 5% marked er nok værst.
Men må innrømme eg håper pcib stiger først langt opp, slik en får vekslet litt tilbake.
Ikke uenig med deg i det.
Veldig illustrerende og selgende slide. Fenger tilhøreren umiddelbart, og budre vært en av de to første slidene i presentasjonen, ikke den siste. PHO har litt å lære om pitching.
Noen som vet hvorfor ikke dato for Q4 res hverken ligger i Oslo børs kalender eller på hjemmesiden til selskapet ?
Fordi de ikke har spikret datoen enda.
Ok, trodde det var regler for sånt
Fra Oslo Børs sin IR-anbefaling:
Takk. Så det er innenfor da
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Fint å se ordet om at blue light også brukes i Surveillance sprer seg
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Fra NCCN guide lines v1 2019 om blue light:
Enhanced Cystoscopy
White light cystoscopy (WLC) is the current standard in the evaluation
and staging of bladder cancer. While WLC has a high sensitivity for
detecting papillary lesions, the technique is limited in its ability to discern
non-papillary and flat lesions from inflammatory lesions, thus reducing
the accuracy of tumor staging. Additionally, small or multifocal lesions
are more difficult to detect with WLC. Several techniques proposed to
enhance imaging are available and include blue light cystoscopy (BLC)
and narrow band imaging (NBI). Both methods report improved staging
when used in conjunction with WLC and with expertise; however, data
are still limited for both methods and WLC remains the mainstay of
bladder cancer staging.
Blue Light Cystoscopy
BLC is a technique that identifies malignant cells through the absorption
of the photosensitizing drug into the urothelial cytoplasm where it enters
heme-biosynthesis metabolism. In normal cells, the photosensitizer is
excreted; however, enzymatic abnormalities in malignant cells result
in the formation of photoactive porphyrins that remain in the cell and
fluorescence with a red emission in the presence of blue light. Earlier
studies used the photosensitizer 5-aminolevulinic acid (5-ALA), although
more recent studies use the only FDA-approved photosensitizer hexyl-
aminolevulinate (HAL).
Several prospective clinical studies have evaluated BLC in conjunction
with WLC and found higher detection rates of non–muscle-invasive
lesions with BLC.9-14 Particularly CIS, which is often missed by WLC,
was detected at a higher rate. A meta-analysis of fluorescence
cystoscopy TURBT in non–muscle-invasive bladder cancer included
12 randomized controlled trials with a total of 2258 patients.15 A lower
recurrence rate was observed (OR, 0.5; P < .00001) with a delayed
time to first recurrence by 7.39 weeks (P < .0001). Recurrence-free
survival was improved at 1 year (HR, 0.69; P < .00001) and at 2 years
(HR, 0.65; P = .0004). However, no significant reduction in the rate of
progression to muscle-invasive bladder cancer was seen (OR, 0.85;
P = .39).
In a meta-analysis from Burger et al,16 1345 patients with Ta, T1 or CIS
disease showed improved detection of bladder tumors and a reduction
in recurrence.16 Compared to WLC, BLC detected more Ta tumors
(14.7%; P < .001; OR, 4.898; 95% CI, 1.937–12.390) and CIS lesions
(40.8%; P < .001; OR, 12.372; 95% CI, 6.343–0.924). Importantly,
24.9% of patients had at least one additional Ta/T1 tumor detected
(P < .001) and improved detection was seen in both primary (20.7%;
P < .001) and recurrent disease (27.7%; P < .001). Another review of
the literature included 26 studies with 5-ALA, 15 studies with HAL, and
2 studies that used both methodologies. The results from this review
also support greater detection and reduced recurrence but no reduction
in disease progression.17
Although most studies have not found a significant reduction in disease
progression, a recent analysis reported a trend towards a lower rate
with the use of BLC compared to WLC (12.2% vs. 17.6%, respectively;
P = .085) with a longer time to progression (P = .05).18 Although BLC
has demonstrated improved detection and reduced recurrence, the
value of this technique in reducing disease progression remains less
established. Therefore, BLC may have the greatest advantage in
detecting difficult-to-visualize tumors (eg, CIS tumors) that may be
missed by WLC but has more limited applicability in disease monitoring.
Other impediments to BLC include the need for appropriate expertise
and equipment to employ this new technology. High false positives
are also attributed to this method and may be increased in patients
who have had a recent TURBT or bacillus Calmette-Guérin (BCG)
instillation, or who have inflammation.17 The limitations of BLC require
judicious application of this additional diagnostic tool.
Var ikke bare bra det som står i nye guidelines:
-
Although BLC
has demonstrated improved detection and reduced recurrence, the
value of this technique in reducing disease progression remains less
established. Therefore, BLC may have the greatest advantage in
detecting difficult-to-visualize tumors (eg, CIS tumors) that may be
missed by WLC but has more limited applicability in disease monitoring. -
High false positives
are also attributed to this method and may be increased in patients
who have had a recent TURBT or bacillus Calmette-Guérin (BCG)
instillation, or who have inflammation. -
The limitations of BLC require
judicious application of this additional diagnostic tool.
bladder.pdf (1,1 MB)
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Om man er usikker på hvor viktig en god refusjon er, så forklarer ihvertfall dette brevet som Photocure sendte til CMS september 2017 konsekvensene av en dårlig en: https://www.regulations.gov/document?D=CMS-2017-0091-3226
direkte link til pdf:
https://www.regulations.gov/contentStreamer?documentId=CMS-2017-0091-3226&attachmentNumber=1&contentType=pdf
limer inn noen korte utdrag:
As soon as CMS announced its decision in late 2012 to package Cysview, hospitals immediately began informing Photocure that they could not offer the new treatment “until the reimbursement issue is settled.”
As a result, numerous hospitals rejected adoption of
Blue Light Cystoscopy with Cysview, severely harming patient access
To date, there are more hospitals that stopped offering Blue Light Cystoscopy with Cysview after the CY 2013/2014 packaged payment policy than hospitals that offer the procedure today. In virtually every instance where hospitals decided to stop offering Blue Light Cystoscopy with Cysview to their patients, hospitals pointed to the packaged payment policy as the reason for their decision
Hundreds of hospitals have rejected adoption of the procedure due to the Medicare policy package for Cysview and C-APC policy.
This is not only problematic for beneficiary care but is also harming the Medicare program itself, given that the peer reviewed literature demonstrates a savings of approximately $4,600 from even one use of Blue Light Cystoscopy with Cysview
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Er det sånn photocure vurderer det selv også? Mener de dette er en fair vurdering?