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

Bladder Cancer
10/07/2020

Lotan Y, et al. BJU Int 2020.

ABSTRACT

OBJECTIVES: To evaluate the utility of blue light flexible cystoscopy (BLFC) for surveillance of non-muscle invasive bladder cancer (NMIBC).

METHODS: Prospective cohort of consecutive patients who underwent office BLFC for NMIBC. Clinical information was collected including cystoscopic findings and pathologic data.

RESULTS: A total of 322 cases were performed on 190 patients. Mean age was 71 years and 83% were men. The highest stage prior to BLFC was Ta, CIS, T1, T2 in 45.3%, 18.4%, 30% and 2%, respectively. Prior to BLFC, 16.8%, 60.5%, 16.8% were low grade, high grade, and CIS, respectively. Intravesical BCG 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 office biopsy and cancer was detected in 13 (87%)(6 CIS, 4 HG Ta, 3 LG Ta). Both WLC and BLFC were positive in 83 (25.8%) cases and 33% had additional tumors found. Cancer was found in 27 (75%) of WLC+/BLFC+ who underwent office biopsy including 19 LGTa, 6 HG Ta and 2 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 biopsy. Further research is needed to determine cost-effectiveness and impact on recurrence rates.