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

Abstract

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.

Performance of Narrow Band Imaging (NBI) and Photodynamic Diagnosis (PDD) Fluorescence Imaging Compared to White Light Cystoscopy (WLC) in Detecting Non-Muscle Invasive Bladder Cancer: A Systematic Review and Lesion-Level Diagnostic Meta-Analysis

“…A phase III prospective study of PDD with HAL found that approximately 20.6% of malignant lesions were only detected with PDD and not WLC, leading to a US consensus statement recommending PDD with HAL for surveillance cystoscopy of NMIBC [8,40]. Adherence to this consensus recommendation for NMIBC surveillance has shown that the use of PDD led to the detection of 33% cancerous lesions over WLC alone [41].…”

The use of blue-light cystoscopy in the detection and surveillance of nonmuscle invasive bladder cancer

“…Following the 2018 AUA consensus statement, Lotan et al [ 24 , 25 ] studied a cohort of 190 patients who underwent office-based BLFC for surveillance of NMIBC. They found that BLFC detected additional cancers in 33% of patients with positive WLC and BLFC.…”

“…They found that BLFC detected additional cancers in 33% of patients with positive WLC and BLFC. [ 25 ] In their group, there were 26 cystoscopies (8%) with negative WLC but positive BLC findings. Eight of these patients had CIS (30.8%), 8 had high-grade Ta (30.8%), and 3 had low-grade Ta (11.5%), while 3 had benign findings (11.5%).…”

Advances in Diagnosis and Therapy for Bladder Cancer

“…Sonn et al TURBT combined with PDD can maximize the tumor resection rate to reduce the recurrence of BCa. The prospective evaluation study of PDD for NMIBC surveillance noted that 33% of additional cancers were detected by PDD, and the recurrence rate of NMIBC detected and resected by PDD was lower than that by WLC [14]. This result is consistent with the findings of the recurrence-focused randomized study from Drejeret al The use of cystoscopy-based PDD for NMIBC surveillance after the first-time TURBT reduced the risk of recurrence with an OR of 0.67 (p = 0.02, 95% CI: 0.48-0.95) [15].…”