Prospective Evaluation of Blue Light Flexible Cystoscopy With Hexaminolevulinate in Non-Muscle-Invasive Bladder Cancer

Yair Lotan1, Iftach Chaplin1, Hamed Ahmadi2, Xiaosong Meng1, Sidney Roberts2, Sanam Seyedian2, Aditya Bagrodia1, Vitaly Margulis1, Solomon Woldu1, Siamak Daneshmand2


Department of Urology, UT Southwestern Medical Center, Dallas, TX, United States.
Department of Urology, University of Southern California, Los Angeles, CA, United States.

PMID: 32648957  DOI: 10.1111/bju.15166


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.

Keywords: blue light flexible cystoscopy; cancer detection; non-muscle invasive bladder cancer.

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