To evaluate the utility of blue-light flexible cystoscopy (BLFC) for surveillance of non-muscle-invasive bladder cancer (NMIBC). Patients and Methods Prospective cohort of consecutive patients who underwent office-based BLFC for NMIBC. Clinical information was collected including cystoscopic findings and pathological data. Results A total of 322 cases were performed on 190 patients. The mean age was 71 years and 83% were men. The highest stage prior to BLFC was Ta, carcinoma in situ (CIS), T1, and T2 in 45.3%, 18.4%, 30% and 2%, respectively. Prior to BLFC, 16.8%, 60.5%, and 16.8% were low grade (LG), high grade (HG), and CIS, respectively. Intravesical bacille Calmette-Gu erin and intravesical chemotherapy were used in 54.2% and 18.4%, respectively. White-light cystoscopy (WLC) and BLFC were both normal in 173 (53.7%) of cases. WLC was normal and BLFC was abnormal in 26 (8%) cases. Of these, 15 had officebased biopsy and cancer was detected in 13 (87%; six CIS, four HG Ta, three LG Ta). Both WLC and BLFC were positive in 83 (25.8%) cases and 33% had additional tumours found. Cancer was found in 27 (75%) of WLC+/BLFC+ who underwent office-based biopsy including 19 LG Ta, six HG Ta, and two CIS. Conclusions Incorporation of BLFC in clinical practice has potential advantages of finding cancer in cases with normal WLC. BLFC detected additional cancers in 33% of patients with positive WLC and BLFC, which can improve surveillance and performance of office-based biopsy. Further research is needed to determine cost-effectiveness and impact on recurrence rates.
Introduction: Bladder cancer is associated with a 78% risk of recurrence at 5 years for nonmuscleinvasive bladder cancer and 45% progression to muscle-invasive disease. 1 This is common in patients with carcinoma in situ (CIS), which can often be missed with standard white light cystoscopy. 2 Additionally, 34-76% of patients have evidence of residual tumors after transurethral resection of bladder tumor 3,5 and patients with incomplete initial resection are at a high risk of recurrence. 4,6,7 Blue light flexible cystoscopy in the office setting improves detection of papillary tumors and CIS, 8 potentially decreasing frequency of delayed detection, possibly prevents disease progression and may improve office-based biopsy efficacy. In this study we present a video demonstrating how blue light flexible cystoscopy can be used in the office setting to assist with detection of papillary tumors and CIS. Materials and Methods: Patients received hexaminolevulinate intravesically before white light flexible cystoscopy and blue light flexible cystoscopy. Suspicious lesions were biopsied with flexible graspers and fulgurated in the office setting when feasible. Results: Patient 1 had a history of high-grade T1 bladder cancer treated with multiple prior surgeries and induction/maintenance Bacillus Calmette Guerin (BCG) with multiple flat lesions that were difficult to observe on white light cystoscopy but readily apparent under blue light. Biopsy demonstrated highgrade urothelial carcinoma. Patient 2 was incidentally found to have focus of CIS involving the bladder neck/prostatic urethra on bipolar transurethral resection of the prostate. Blue light cystoscopy identified a patch lateral to the left ureteral orifice, which demonstrated CIS on office biopsy. Patient 3 had a history of CIS treated with induction and maintenance BCG without recurrence since 2016. Blue light cystoscopy identified small papillary lesions, including one not seen on white light cystoscopy that were biopsied and fulgurated with pathology analysis demonstrating low-grade Ta bladder cancer.
INTRODUCTION AND OBJECTIVE:A second transurethral resection within 2 to 6 weeks after the initial resection (i.e. re-resection) is recommended for patients diagnosed with primary T1 bladder cancer as prior studies suggest therapeutic, diagnostic, and prognostic benefits. Results on survival endpoints, however, are sparse, conflicting, and often affected by various biases. Hence, we aimed to provide real-world evidence by investigating the survival benefit of reresection in T1 bladder cancer at the population level.METHODS: Retrospective population-wide observational cohort study based on pathology reports linked to health administrative data. We identified patients who were diagnosed with T1 bladder cancer in the province of Ontario (01/2001-12/2015) and used billing claims to ascertain whether they received re-resection within 2 to 10 weeks. The time-dependent effect of re-resection on survival outcomes was modeled by Cox proportional hazards regression (unadjusted and adjusted for numerous assumed patientand surgeon-level confounding variables). Effect measures were presented as hazard ratios and 95% confidence intervals.RESULTS: We identified 7,666 patients of which 2,162 (28.7%) underwent re-resection after a median time of 45 days (interquartile range: 35-56 days). The probability of dying from bladder cancer was consistently lower than the probability of dying from other causes (5 years: 15.8% versus 25.0%, 10 years: 18.7% versus 40.9%). Patients who received re-resection were less likely to die from any causes (0.68 [0.63-0.74], p<0.001) and from bladder cancer (0.66 [0.57-0.76], p<0.001) during any time of follow-up. After adjusting for all assumed confounding variables, re-resection was still significantly associated with a lower overall mortality (0.88 [0.81-0.95], p<0.001) while the association with cancer-specific survival marginally lost its statistical significance (0.87 [0.75-1.02], p[0.08).CONCLUSIONS: To the best of our knowledge, this populationwide study represents the largest cohort of patients diagnosed with T1 bladder cancer and provides real-world evidence supporting the utilization of re-resection in this group of patients.
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