Blue light cystoscopy may be useful in bladder cancer diagnosis
Blue light cystoscopy (BLC) delivers increased detection rates of carcinoma in-situ and papillary lesions, leading to upstaging or upgrading in a substantial proportion of patients, compared with a cystoscopic examination utilizing a white light (WLC), a study has shown.
The analysis included 533 consecutive patients (median age 72 years; 84 percent male) with suspected or known nonmuscle-invasive bladder cancer who were undergoing transurethral resection of bladder tumour. Hexaminolevulinate was injected into the bladder 1–3 hours prior to evacuation and inspection. Primary endpoints included the sensitivity and specificity of BLC, WLC and the combination of both in detecting any malignancy reported on final pathology.
A total of 641 BLC procedures were performed, from which 1,632 pathology samples were obtained. There were 85 patients (16 percent) who underwent repeat BLC.
Sensitivity in diagnosing any malignant lesion was 76 percent with WLC, 91 percent with BLC and 98.5 percent with the combination. The addition of BLC to standard WLC improved detection rate by 12 percent for any papillary lesion and by 43 percent for carcinoma in-situ.
The use of blue light led to detection of an additional 206 lesions, which were undetected with WLC, in 133 patients. Moreover, BLC exclusively detected malignant lesions in 41 patients, as well as resulted in a change in recommended management in 74 patients with multifocal disease.
False-positive rate was 30 percent for BLC and 25 percent for WLC.
In terms of safety, minor complications including bladder or urinary tract pain were reported in 18 patients following hexaminolevulinate injection, but none were attributable to the drug. Mild dermatologic hypersensitivity reaction was documented in one patient (0.2 percent).
The present data show that BLC may be useful for detecting bladder cancer and is very safe with multiple repeat use, researchers said.