Blue light cystoscopy improves lesion detection in NMIBC

Blue light flexible cystoscopy (BLFC) as an adjunct to white light cystoscopy (WLC) was found to improve the detection of malignant lesions in surveillance of patients with non–muscle-invasive bladder cancer (NMIBC), according to results from the Nordic registry study.^1,2

Discomfort during blue light cystoscopy was reported by 34 patients.

The data from the prospective, observational, multi-center study were presented by Karsten Zieger, MD, PhD, at the 2023 American Urological Association Annual Meeting in Chicago, Illinois. Zieger is a urologist at Lillebælt Hospital in Vejle, Denmark.

“We had 319 individuals and performed 436 BLFC procedures and took a lot of biopsies. The results [were] that 28% of the malignant findings were only seen by blue light; 5% were not seen by blue light…. Our conclusion is that the BLC improves the hit rate of the biopsies in surveillance of NMIBC,” said Zieger during the presentation.

Among all patients included in the study, 172 (54%) were high risk, 136 (43%) were intermediate risk, and 11 (3%) were low risk according to European Association of Urology risk guidelines. Biopsies were taken from 452 lesions in total.

Suspicious lesions were observed in 318 (73%) cystoscopies using blue light or white light. Malignancy was seen in 133 lesions, with 126 (31%) lesions being positive for blue light and 7 (16%) lesions being negative for blue light. Pathology reported malignancy among 36% of biopsies, 18 of which were carcinoma in situ. Of all malignant lesions, 28% were only identified with blue light.

Patients who have high-risk disease were shown to benefit most from blue light. Those who were found to have small recurrences underwent office fulguration, 45 were referred to transurethral resection of bladder tumor, and 82 received adjuvant intravesical therapy.

Discomfort during BLFC was reported by 34 patients.

Physicians also reported an improved confidence with the use of combination BLC in 84% of the cystoscopies, identifying the main advantage being stronger confidence in confirming or refuting a suspicious lesion.

The authors concluded, “The combination of BLC with immediate fulguration of tumors in an outpatient setting may positively affect the patients’ burden in NMIBC. The [effect] on patients’ overall outcome is target of future evaluations.”

References

1. Egbert Arnold Zieger K, Young-Halvorsen K, Malmstrom PU. The role of flexible blue light cystoscopy in surveillance of non-muscle–invasive bladder cancer. Results from a Nordic registry. Presented at: American Urological Association Annual Meeting, April 28-May 1, Chicago. Abstract MP08-15

2. Photocure: Nordic registry clinical data and multiple scientific programs at AUA 2023 Congress reinforce the benefits of Blue Light Cystoscopy. News release. Photocure. May 2, 2023. Accessed May 15, 2023. https://www.prnewswire.com/news-releases/photocure-nordic-registry-clinical-data-and-multiple-scientific-programs-at-aua-2023-congress-reinforce-the-benefits-of-blue-light-cystoscopy-301813455.html