AUA 2020: Role of Blue Light Cystoscopy in Detecting Invasive Bladder Tumor: Data from Multi-Institutional Registry

(UroToday.com) Blue light cystoscopy has been shown to not only increase the detection rate of non-muscle invasive bladder cancer (20% for any tumor) including carcinoma in situ (CIS; 25-43%), it also decreases recurrence (27% at 12 months) and progression rates (24% at 24 months). Flexible blue light cystoscopy was approved by the U.S. Food and Drug Administration (FDA) in 2018 for use in the surveillance setting and was demonstrated to improve detection.¹ However, there are still unanswered questions regarding the role of blue light in changing management of patients with non-muscle invasive bladder cancer at high-risk for progression to muscle-invasive disease. At the American Urological Association 2020 Virtual Annual Meeting, Hamed Ahmadi, MD, and colleagues presented results of their assessment of the role of blue light cystoscopy in detecting invasive tumors that were not visible on white light cystoscopy, in patients undergoing blue light cystoscopy.

Using the Cysview registry database (9 different institutions nationwide), which prospectively collects information on all patients who undergo transurethral resection of bladder tumor (TURBT) using blue light cystoscopy, patients who had at least one white light -/blue light + lesion with invasive pathology (≥ T1) as highest stage tumor were identified. All patients with at least one white light -/blue light + lesion and also the ones with invasive tumors were also selected as denominators. Relevant baseline information and outcome data were gathered. Proportion of invasive tumor in white light -/blue light + group was compared to white light +/blue light + and white light +/blue light - groups.

For this study, there were a total of 3,514 lesions (1,257 unique patients) with complete information available; 818 (23.2%) lesions were white light -/blue light + and 494 (14%) lesions were invasive tumors. Of all white light -/blue light + lesions, 55 (7%) lesions (47 unique patients) had at least one white light -/blue light + invasive tumor. Of all invasive tumors, 55 (11%) lesions were white light -/blue light + (48 T1 and 7 T2):

With regard to white light -/blue light + T1 lesions, 28 (58%) had concomitant carcinoma in situ (CIS) and 23 (48%) had at least another T1 lesion detected during TURBT. Among those accompanying lesions, 20 (70%) of CIS lesions and 9 (38%) of other T1 lesions were also white light -/blue light +. Of patients with complete follow up, 23/32 (67%) patients underwent radical cystectomy, and 7/32 underwent BCG induction +/- maintenance therapy.  Among those undergoing radical cystectomy, 50% had pathologic upstaging and 18% were pN+.

Dr. Ahmadi concluded his presentation of the Cysview registry database with the following concluding statements:

• A considerable proportion of invasive lesions are only detectable by blue light cystoscopy
• These findings suggest an additional benefit of blue light cystoscopy in earlier detection of invasive bladder tumors that could change the treatment approach and ultimately lead to improved survival in this high-risk population

Presented by: Hamed Ahmadi, MD, Clinical Instructor of Urology, University of Southern California, Los Angeles, CA, USA

Written By: Zachary Klaassen, MD, MSc, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Augusta, GA, USA, Twitter: @zklaassen_md, at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27-28, 2020. 

References: 

1. Lotan Y, Bivalacqua TJ, Downs T, et al. 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. Nat Rev Urol 2019 Jun;16(6):377-386.