Blue light more sensitive than white light cystoscopy for bladder cancer surveillance
Office-based blue light flexible cystoscopy (BLFC) significantly improves detection of patients with recurrent bladder cancer and is safe when performed for surveillance compared white light flexible cystoscopy (WLFC), as shown in a recent study.
Additionally, performing blue light cystoscopy (BLC) in the operating room (OR) significantly boosts detection of carcinoma in situ (CIS), as well as identifies lesions missed with white light cystoscopy (WLC).
The phase III multicentre study compared BLFC with WLFC in the detection of bladder cancer recurrence during surveillance. A total of 304 nonmuscle invasive bladder cancer patients received intravesical hexaminolevulinate before WLFC and BLFC. Those found to have suspicious lesions were referred to the OR for repeat WLC and BLC. All suspected lesions were biopsied or resected, with specimens examined by an independent pathology consensus panel.
The primary endpoint was the proportion of patients with histologically confirmed malignancy detected only with BLFC. Additional endpoints included false positive rate, detection of CIS, and additional tumours detected only with BLC.
Following surveillance, 103 patients were referred to the OR. Of these patients, 63 had confirmed malignancy, including 26 with CIS. Recurrence was detected only with BLFC in 13 of 63 patients (20.6 percent; p<0.0001), and five of these patients had confirmed CIS.
From the OR examination, 26 of 63 patients (41 percent) had confirmed CIS, with nine cases (34.6 percent) detected only with BLC (p<0.0001). BLC identified additional malignant lesions in 29 patients (46 percent).
False positive rates were similar between WLC and BLC (9.1 percent). There were 12 adverse events reported during surveillance, but none of which were serious.