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BLUE LIGHT CYSTOSCOPY FOR DIAGNOSIS OF UROTHELIAL BLADDER CANCER: RESULTS FROM A PROSPECTIVE MULTICENTER REGISTRY

Login to Access Video or Poster Abstract: MP15-02
Sources of Funding: None

Introduction

Blue Light Cystoscopy (BLC) using hexaminolevulinate (Cysview) improves the detection of non-muscle invasive bladder cancer (NMIBC). We report on our experience from the multi-center prospective BLC with Cysview Registry and its utility in different scenarios._x000D_

Methods

Under IRB approval, we prospectively enrolled consecutive patients undergoing transurethral resection of bladder lesions into the registry at 9 different centers. Patients who refused catheter insertion (8), had pure upper tract or prostatic urethral lesions (7) or were lost to follow-up (10) were excluded from the study._x000D_

Results

Between April 2014 and Oct 2016, 1325 separate lesions were identified from 517 BLC procedures on 426 patients (mean age 72 years, 84% male). 68 patients (16%) underwent repeat use (2-5). Using final pathology as the reference standard, the sensitivity of WL, BL and the combination for any malignant lesion was 75%, 90% and 98.5% respectively. The addition of BL to standard WLC increased the detection rate by 12% for any papillary lesions and 44% for CIS (Table 1). Within the WL negative group, an additional 170 lesions in 105 (25%) patients were detected exclusively with the addition of BL. In multifocal disease, in addition to WL-detected lesions, BLC resulted in upstaging in 54 (13 %) patients, resulting in a change in management. Overall false-positive (FP) rate was 26% for WL and 32% for BL. 164 (39%) patients received BCG at least 6 weeks prior to BLC, with a positive predictive value (PPV) of BLC-detected malignancy being 55% (FP=35%). 82 biopsies were taken from margins of a previous resection site (with more than 6 weeks interval), wherein the PPV of BLC was 51% for malignancy (FP=33%) (figure 2). Among the positive/suspicious cytology patients who had no lesions on WL (144 total), BL was able to detect an extra 57 malignant lesions in 36 patients (sensitivity 92%). There was one mild dermatologic hypersensitivity reaction noted (0.2%). 40 (12%) patients eventually underwent cystectomy, 4 (10%) of whom exclusively because of lesions detected by BLC. _x000D_

Conclusions

BLC significantly increases detection rates of CIS and papillary lesions over WLC alone and can result in upstaging or upgrading in about 13% of patients. Recent BCG therapy does not appear to impact BLC accuracy. Repeat use of Cysview for BLC is safe.

Funding

None

Authors
Soroush T Bazargani
Hooman Djaladat
Anne Schuckman
Badrinath Konety
Trinity J Bivalacqua
Jeff Holzbeierlein
Brian Willard
Jennifer Taylor
Joseph Liao
Kamal Pohar
James Tierney
siamak Daneshmand
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