Takk for innlegget ditt, alltid nyttig å høre (in)direkte fra urologer. Det motiverte meg til å prøve å finne ut av noe av det du spør om. Jeg er på ingen måte en fagperson, så det må alle som leser dette ha i bakhodet! Tar imot korrigeringer med glede.
- Frekvens på bruk av BLC
I denne videoen ( https://tinyurl.com/22vmec7y ) drøftes den lave oppslutningen BLC har i USA. Den studien han i videoen har gjort, viser at det er ca 10 % av TURBT-prosedyrene som utføres med BLC der utstyret er tilgjengelig. Så kan man jo bare tenke seg hvor lav andelen er totalt, siden mange ikke har utstyret som kreves (1,8 %). Studien gikk frem til mars 2020, så er jo ikke helt oppdaterte tall, men dog. Så dersom de lykkes med vekst, så er det nok å ta av.
- Ease of use
I samme video som jeg nevner i forrige punkt deler urologen sine tanker. Han sier noe om at det er en læringskurve ved bruk av BLC, at de første gangene kan alt se rosa ut. Han mener det vil være en stor forskjell i brukervennlighet ut i fra hvorvidt de som tar imot pasientene ved ankomst kan sette kateter («workflow is pretty easy») eller ikke. Han tror det kan være et hinder for bruk i klinikker hvor dette ikke er mulig.
I en annen video ( https://tinyurl.com/yckzrhfx ) sier urologen om det å måtte sette inn kateter og at pasienten deretter må vente en time: "How you manage that in your clinic practice when you’re doing 8 or 9 cystos in a half day, is really challenging, and I haven’t figured that out.» (Ca 12:15) Jeg tenker da at det er helt avgjørende for Photocure å selge seg inn i klinikker eller sykehus som har et effektivt system og som har kvalifisert personell i alle ledd. Da er det ikke sikkert BLC er så mye mindre tidseffektivt.
- Hva er best?
Det er ikke gjort så mange studier som sammenligner BLC vs NBI. De jeg har funnet er små og har sikkert en del svakheter. Uthevingene er mine. Alle studiene er av relativt ny dato.
Comparison between 5-aminolevulinic acid photodynamic diagnosis and narrow-band imaging for bladder cancer detection | BMC Urology | Full Text
(114 pasienter, 282 lesions)
«In this study, 5-ALA-PDD was superior and considered more useful than NBI in reducing the number of missed tumours.»
«5-ALA-PDD at the time of TURBT increased the detection rate of bladder cancer and especially of flat lesions such as CIS, compared to NBI.»
«The sensitivities of WL, PDD, and NBI for detecting urothelial carcinoma were 88.1%, 89.6%, and 76.2%, respectively. The specificity, positive predictive value, and negative predictive value for detecting urothelial carcinoma were 47.5%, 80.9%, and 61.3%, respectively, for WL; 22.5%, 74.5%, and 46.2%, respectively, for PDD; and 46.3%, 78.2%, and 43.5%, respectively, for NBI. PDD was significantly more sensitive than NBI for all lesions (p < 0.001) and carcinoma in situ (CIS) lesions (94.6% vs. 54.1%, p < 0.001).»
Metastudie, 22 artikler med totalt 4519 pasienter.
«We confirmed that recurrence rate at 12 months in patients with non-muscle-invasive bladder cancer was significantly reduced when BLC was performed (PPD with HAL and/or 5-ALA) at the time of TURBT compared to WLC, regardless of SIIC. This reduction in the recurrence rate afforded by BLC was significantly heightened by adding SIIC (BLC plus SIIC), with approximately 32% improvement in OR for recurrence rate at 12 months. The use of NBI at the time of TURBT, with or without SIIC, resulted in ORs (0.653 and 0.385, respectively) that were not statistically different from those associated with WLC alone (Figs 3 and 4). However, according to the SUCRA ranking probability analysis, NBI, both with and without SIIC, was better than WLC alone in terms of 12-month recurrence risk.»
https://www.goldjournal.net/action/showPdf?pii=S0090-4295(21)01151-1 1132 TURBT-prosedyrer på ett sykehus.
«We found that NBI has an overall higher detection
rate of CIS compared to PDD. This study does not reduce
the detection rate of CIS after shifting from the use of
PDD to NBI assisted TURBT. As NBI has less clinical
limitations and is a 1 time expense compared to PDD,
NBI is therefore preferable in detecting CIS. This study
does not investigate whether or not the recurrent rate of
CIS is affected by the use of NBI assisted TURBT. Going
forward this matter of fact is of course interesting to study.»
Denne sistnevnte studien har ifølge forskerne en del begrensninger:
«There are several limitations of the current study.
Beside the retrospective design, most importantly, PDD
was only used in approximately 1 quarter of the patients
in period 1. The majority of the included procedures with
PDD are “primary TURBT,” the reasons for not using the
PDD is not stated. PDD can be challenging to use due to
logistical challenges such as, suboptimal retention time in
the bladder. Therefore, it is possible that the overall CIS
detection rate is underestimated in period 1. However,
these data indicate the difference in everyday practise
compared to a clinical study.»
«It is most likely that the improved detection rate of CIS in period 2 is due to the convenient accessibility and reduced cost of NBI, but we do not know if NBI is superior to PDD in detecting CIS.»
Så en ganske lite konkluderende studie vil jeg si, uten å ha peiling på forskning.
- Joker
Imagin Medical er et bittelite selskap som blant annet skriver dette på sin hjemmeside ( https://imaginmedical.com/ ) :
«Imagin Medical hopes to significantly accelerate the transition to BLC and make it more accessible to those who will benefit from it. Imagin is developing a blue light imaging system that would maintain the advantages of the current BLC method while offering state-of-the-art technology that provides surgeons with real-time, simultaneous, side-by-side white and blue light images at significantly lower cost. Leading urologists have told Imagin that the simultaneous, side-by-side view would make bladder cancer visualization and removal more accurate and efficient and help advance the goal of reducing recurrence rates. Imagin is designing its system to adapt to most endoscopes on the market, which would allow hospitals to use equipment they already own and save additional costs.»
På siden kan dere også finne en oppdatert selskapspresentasjon ( https://ir.imaginmedical.com/wp-content/uploads/sites/2/2022/01/Imagin-Presentation-Website-1-13-22.pdf ) og mer detaljer om teknologien. Jeg vet ikke hvorvidt dette er innertier eller skivebom, ei heller hvordan patentsituasjonen vil påvirke det at BLC blir mer «demokratisert». Men sikkert verdt å holde et øye på alt som kan forenkle BLC.
Til alle som kan mer enn meg, vennligst dementer eventuelle feilaktige påstander her og opplys meg! Innlegget må leses som en lekmanns høyttenking