AUA 2017: Blue-Light Cystoscopy for Diagnosis of Urothelial Bladder Cancer: Results From a Prospective Multicenter Registry
This study prospectively enrolled consecutive patients undergoing transurethral resection of bladder lesions into the registry at nine different centers and took place between April 2014 and October 2016. Exclusion criteria included those refusing catheter insertion, patients with pure upper tract or prostatic urethral lesions, and individuals who were lost to follow-up.
Overall, 1325 separate lesions were identified from 517 BLC procedures in 426 patients with a mean age of 72 years, and with 84% being male. Using final pathology as the reference standard, the sensitivity of white-light cystoscopy (WLC), BLC, and their combination for any malignant lesion was 75%, 90%, and 98.5%, respectively. The addition of BLC to standard WLC increased the detection rate by 12% for any papillary lesion and 44% for carcinoma in situ. Within the WLCs not identifying any lesions, an additional 170 lesions in 105 (25%) patients were detected exclusively with the addition of BLC. In addition, in patients with multifocal disease, BLC resulted in upstaging in 54 (13%) patients, leading to a change in management. The overall false-positive rate was 26% for WLC and 32% for BLC. Precisely 164 (39%) patients received Bacillus Calmette-Guerin at least 6 weeks prior to BLC, with a positive predictive value of BLC-detected malignancy being 55%. Among the positive/suspicious cytology patients who had no lesions on WLC (144 in total), BLC was able to detect an extra 57 malignant lesions in 36 of them, demonstrating a sensitivity of 92%. Only one mild dermatologic hypersensitivity reaction was noted (0.2%). Eventually, 40 (12%) patients eventually underwent cystectomy, four (10%) of whom did so exclusively because of lesions detected by BLC.
Summarizing these results, it seems that BLC has a significant increased detection rate of carcinoma in situ and papillary lesions when compared with WLC alone and is quite safe for use. Most importantly, BLC can lead to upstaging or upgrading in some 13% of patients. Lastly, recent Bacillus Calmette-Guerin therapy does not appear to impact BLC accuracy.
Presented By: Soroush T. Bazargani, MD, Los Angeles, CA
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA