Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Zare, Reza; Grabe, Magnus; Hermann, Gregers G.; Malmström, Per Uno

doi:10.2147/rru.s141314

Cited by 7 publications

(13 citation statements)

References 19 publications

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“…These findings are consistent with prior reports that found a lower sensitivity of cytology in contemporary series [9]. © 2020 The Authors BJU International © 2020 BJU International 111 for surveillance in 69 patients with NMIBC [6]. There were 14 patients with confirmed cancer of which three were found by BLFC only (two Ta and one CIS).…”

Section: Discussionsupporting

confidence: 89%

“…One limitation of this trial was the evaluation of a cohort with only intermediate‐ and high‐risk disease with one time use of BLFC. There are limited real‐world data using BLFC, which is confined to European centres [6]. In the present study, the utility of BLFC was evaluated in a prospective cohort of consecutive patients with NMIBC who underwent BLFC at two major academic high‐volume bladder cancer centres.…”

Section: Introductionmentioning

confidence: 99%

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Prospective evaluation of blue‐light flexible cystoscopy with hexaminolevulinate in non‐muscle‐invasive bladder cancer

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of blue‐light flexible cystoscopy with hexaminolevulinate in non‐muscle‐invasive bladder cancer

et al. 2020

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“…Of the 14 patients in total with confirmed tumours, 11 could be managed concomitantly with fulguration, whereas 3 were referred to the operating room. No adverse events attributable to BLFC were reported 30 .…”

Section: Experience With Blfc the Nordic Perspectivementioning

confidence: 95%

“…Zare et al 30 published a multicentre prospective observational assessment of BLFC for surveillance and fulguration that included 69 patients with a mean age of 70 years (range 33-89 years) and a mean duration since NMIBC diagnosis of 8 years. Most patients had highgrade cancer at initial diagnosis (52 of 69) and were at high risk of recurrence (48 of 69).…”

Section: Experience With Blfc the Nordic Perspectivementioning

confidence: 99%

Blue light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on optimal use in the USA — update 2018

et al. 2019

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Approximately 75% of newly diagnosed bladder cancers are not muscle invasive at presentation 1. Non-muscleinvasive bladder cancer (NMIBC) has a high recurrence rate (50-70% of patients), and 10-20% of NMIBCs (especially high-risk disease) will progress to muscle-invasive disease (depending on stage and grade at diagnosis) 1. Initial management of NMIBC includes transurethral resection of bladder tumour (TURBT). Use of intravesical BCG or intravesical chemotherapy in intermediaterisk and high-risk disease decreases the risk of recurrence and progression 2,3. Surveillance protocols for patients with NMIBC involve frequent cystoscopic evaluation primarily in the outpatient setting 2,4. White light cystoscopy (WLC) has long been the standard-of-care modality for surveillance with a high sensitivity for detection of papillary tumours 2,4. A known limitation of WLC is in detecting carcinoma in situ (CIS), which can result in a false-negative rate as high as 20% 5,6. Thus, some patients with recurrence are missed and might progress to worse disease as their disease was unrecognized. The inadequacy of WLC to visualize tumours has led to the development of enhanced cystoscopic techniques. The goal of these techniques is to reduce early recurrences, as many are tumours that were missed or inadequately initially resected owing to suboptimal visualization 7. WLC remains the standard-of-care technique for the detection of bladder cancer, but extensive data have shown that enhanced cystoscopy with blue light frequently detects tumours that are missed by white light 8. The American Urological Association (AUA)-Society of Urologic Oncology (SUO) guidelines for managing NMIBC state that "in a patient with NMIBC, a clinician should offer blue light cystoscopy at the time of TURBT, if available, to increase detection and decrease recurrence. (Moderate Recommendation; Evidence Strength: Grade B)" 2. The European Association of Urology (EAU) guidelines also state that fluorescence-guided biopsy and resection are more sensitive than conventional procedures for the detection of malignant tumours, particularly for CIS (evidence level: 1a) 4 .

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“…For smaller tumours one-swing loop resection or the "grasp and bite technique" can also be used [21]. Finally, thermal/laser ablation in local anaesthesia of small lesions with strong low-grade conviction may be employed, especially in an outpatient follow-up setting [22]. Nonetheless, being therapeutic enough in selected cases, fulguration cannot be classified as en bloc resection.…”

Section: En Bloc Transurethral Resection Of Bladder Tumourmentioning

confidence: 99%

Technical developments in transurethral resection of bladder tumours

Pastuszak

Zdrojowy

Poletajew

et al. 2019

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Bladder cancer is one of the most common malignancies worldwide. The transurethral resection of bladder tumour (TURB) remains the gold standard in both diagnostics and treatment. Because of the importance of TURB in bladder cancer management and the fact that TURB is one of the most commonly performed urologic procedures, it is the subject of continuous technological development. The latest advances in the field of endourology are aimed at increasing surgical accuracy and thus reducing the risk of bladder tumour recurrence and progression. However, despite the constant progress in technology and technique, there are still a lack of good quality data showing the superiority of any of the methods. The aim of this paper is to present available data on new technological developments in surgical technique of TURB. Advantages and disadvantages of currently available methods are discussed, and literature showing their effectiveness and safety is shown.

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Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Cited by 7 publications

References 19 publications

Prospective evaluation of blue‐light flexible cystoscopy with hexaminolevulinate in non‐muscle‐invasive bladder cancer

Prospective evaluation of blue‐light flexible cystoscopy with hexaminolevulinate in non‐muscle‐invasive bladder cancer

Blue light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on optimal use in the USA — update 2018

Technical developments in transurethral resection of bladder tumours

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