Blue light cystoscopy enables earlier detection of invasive bladder tumors

Analyses of data from a multi-institutional registry show that blue light cystoscopy (BLC) using hexaminolevulinate HCl (Cysview) detects invasive bladder tumors that are missed by white light cystoscopy (WLC) in an appreciable number of patients. The research was presented as part of the American Urological Association 2020 Virtual Experience.

“The value of BLC compared to WLC for increasing detection of nonmuscle-invasive bladder cancer including carcinoma in situ (CIS) has been well demonstrated, and the use of BLC has also been shown to be associated with a decreased recurrence rate after TURBT [transurethral resection of bladder tumor] and possibly a lower progression rate,” said Hamed Ahmadi, MD, lead author and urologic oncology fellow, University of Southern California, Los Angeles.

Siamak Daneshmand, MD, is senior author of the research and director of urologic oncology, University of Southern California. He told Urology Times, “The findings of our study indicate an additional benefit of BLC for enabling earlier detection of invasive bladder tumors. The decision to use BLC has implications for the treatment approach in patients with these significant cancers, and its use could ultimately be shown to lead to improved survival for this high-risk population.”

The study was conducted by reviewing the Cysview registry database that prospectively collects demographic and clinical information for all patients who undergo TURBT using BLC at 9 institutions. It included data on 3514 lesions of 1257 unique patients.

Of the 3514 lesions, 494 (14%) were invasive (≥pT1) and 818 (23.2%) were not visible on WLC but detected using BLC (WLC-/BLC+). Of the 494 invasive lesions, 55 (11%, in 47 unique patients) were WLC-/BLC+. Further analyses of the invasive lesions showed that 13.8% of the pT1 tumors and 6% of the pT2 tumors were WLC-/BLC+, meaning they were not visible on WLC and detected only because of BLC. The 55 invasive WLC-/BLC+ lesions represented 7% of the WLC-/BLC+ lesions. They included 48 pT1 tumors and 7 pT2 tumors.

During TURBT among the 47 patients with invasive WLC-/BLC+ lesions, 28 (60%) were found to have concomitant CIS, and 23 (49%) had at least one other T1 lesion.

“Interestingly, T1 with concomitant CIS or multifocal T1 disease was only visible on BLC and not WLC in 21 of the 47 patients (45%),” Ahmadi said.

Data on follow-up management was available for 32 patients with a WLC-/BLC+ invasive lesion of which, 22 (69%) underwent radical cystectomy. The presence of high-risk features on TURBT that led to recommendation of radical cystectomy was only based on BLC findings in 18/22 (82%) patients. Among 22 patients who underwent radical cystectomy, pathologic upstaging occurred in 11 patients (50%), and 4 patients (18%) were found to be node positive.

Badrinath Konety, MD, MBA, professor and Dougherty Family Chair in Urologic Oncology, University of Minnesota, Minneapolis, is a coauthor of the study. He told Urology Times^® that previous studies have looked at the performance of BLC for detecting invasive bladder tumors that are not visualized with WLC. The current investigation stands out from the earlier research because of its size and real-world setting.

“Previous studies have looked at different aspects of the role of BLC, including for detecting invasive tumors, but they involved smaller cohorts and had limited power. To our knowledge, we believe our multi-institutional registry study, which includes patients from 9 institutions undergoing BLC for either initial diagnosis or follow-up, represents the largest population in which the role of BLC for detecting invasive tumors has been examined.”

Disclosures: Konety is a clinical study investigator with Photocure Inc. Daneshmand is a clinical study investigator and paid consultant for Photocure.