recurrence rates of non-muscle invasive bladder cancer (NMIBC). We report updated results from an ongoing prospective multicenter registry. METHODS: From April 2014 to October 2017, patients from 9 different centers undergoing TURBT for NMIBC were enrolled in a prospective registry. All lesions were assessed using BLC and white light cystoscopy (WLC). Flat lesions were defined as lesions with a flat appearance or appearance consistent with carcinoma-in-situ. Sensitivity and specificity of cystoscopic assessment was determined by comparison to the gold-standard pathologic diagnosis of the individual lesions. RESULTS: A total of 749 patients underwent 933 TURBT and 2,268 separate lesions were identified and resected. Mean age was 73 years and 83% were male. For detection of any malignancy, the sensitivity of BLC (91%) was higher than WLC (79%, p<0.001) and the combination had a sensitivity of 99%. The improved detection rate of any malignancy was notable for flat lesions (BLC 91% vs. WLC 64%, p<0.001). The sensitivity of BLC was also higher for patients with previous BCG treatment (p<0.001). BLC outperformed WLC for all TURBT indications including abnormal cytology. BLC had higher sensitivity compared to WLC for all topographic regions of the bladder; however, the positive predictive value (PPV) of BLC was reduced to 58% for lesions in the prostatic urethra, bladder neck, or trigone compared to 66% PPV for lesions on the anterior, posterior, lateral wall or dome. The number needed to screen with BLC for the diagnosis of an additional malignant lesion was 5. 307 patients had lesions only visible on BLC and 29 of these patients underwent radical cystectomy including 4 patients with tumors identified solely on BLC. CONCLUSIONS: BLC improves detection rates for NMIBC, particularly for flat appearing lesions. The number needed to screen for the diagnosis of an additional malignant lesion was 5. Improved detection rates for BLC are maintained for all TURBT indications and all topographic locations within the bladder.
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