Siamak Daneshmand1, Sanjay Patel2, Yair Lotan3, Kamal Pohar4, Edouard Trabulsi5, Michael Woods6, Tracy Downs7, William Huang8, Jeffrey Jones9, Michael O'Donnell10, Trinity Bivalacqua11, Joel DeCastro12, Gary Steinberg13, Ashish Kamat14, Matthew Resnick15, Badrinath Konety16, Mark Schoenberg17, J Stephen Jones18. 1. University of Southern California, Los Angeles, California. Electronic address: daneshma@med.usc.edu. 2. University of Oklahoma, Oklahoma City, Oklahoma. 3. University of Texas Southwestern Medical Center, Dallas, Texas. 4. Ohio State University, Columbus, Ohio. 5. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. 6. University of North Carolina, Chapel Hill, North Carolina. 7. University of Wisconsin, Madison, Wisconsin. 8. New York University School of Medicine, New York, New York. 9. Veterans Affairs Medical Center, Houston, Texas. 10. University of Iowa, Iowa City, Iowa. 11. Johns Hopkins University, Baltimore, Maryland. 12. Columbia University Medical Center, New York, New York. 13. University of Chicago, Chicago, Illinois. 14. University of Texas M. D. Anderson Cancer Center, Houston, Texas. 15. Vanderbilt University, Nashville, Tennessee. 16. University of Minnesota, Minneapolis, Minnesota. 17. Montefiore Medical Center, Bronx, New York. 18. Cleveland Clinic, Cleveland, Ohio.
Abstract
PURPOSE: We compared blue light flexible cystoscopy with white light flexible cystoscopy for the detection of bladder cancer during surveillance. MATERIALS AND METHODS: Patients at high risk for recurrence receivedhexaminolevulinate intravesically before white light flexible cystoscopy and randomization to blue light flexible cystoscopy. All suspicious lesions were documented. Patients with suspicious lesions were referred to the operating room for repeatwhite and blue light cystoscopy. All suspected lesions were biopsied or resected and specimens were examined by an independent pathology consensus panel. The primary study end point was the proportion of patients with histologically confirmed malignancy detected only with blue light flexible cystoscopy. Additional end points were the false-positive rate, carcinoma in situ detection and additional tumors detected only with blue light cystoscopy. RESULTS: Following surveillance 103 of the 304 patients were referred, including 63 with confirmed malignancy, of whom 26 had carcinoma in situ. In 13 of the 63 patients (20.6%, 95% CI 11.5-32.7) recurrence was seen only with blue light flexible cystoscopy (p <0.0001). Five of these cases were confirmed as carcinoma in situ. Operating room examination confirmed carcinoma in situ in 26 of 63 patients (41%), which was detected only with blue light cystoscopy in 9 of the 26 (34.6%, 95% CI 17.2-55.7, p <0.0001). Blue light cystoscopy identified additional malignant lesions in 29 of the 63 patients (46%). The false-positive rate was 9.1% for white and blue light cystoscopy. None of the 12 adverse events during surveillance were serious. CONCLUSIONS:Office based blue light flexible cystoscopy significantly improves the detection of patients with recurrent bladder cancer and it is safe when used for surveillance. Blue light cystoscopy in the operating room significantly improves the detection of carcinoma in situ and detects lesions that are missed with white light cystoscopy.
RCT Entities:
PURPOSE: We compared blue light flexible cystoscopy with white light flexible cystoscopy for the detection of bladder cancer during surveillance. MATERIALS AND METHODS:Patients at high risk for recurrence received hexaminolevulinate intravesically before white light flexible cystoscopy and randomization to blue light flexible cystoscopy. All suspicious lesions were documented. Patients with suspicious lesions were referred to the operating room for repeat white and blue light cystoscopy. All suspected lesions were biopsied or resected and specimens were examined by an independent pathology consensus panel. The primary study end point was the proportion of patients with histologically confirmed malignancy detected only with blue light flexible cystoscopy. Additional end points were the false-positive rate, carcinoma in situ detection and additional tumors detected only with blue light cystoscopy. RESULTS: Following surveillance 103 of the 304 patients were referred, including 63 with confirmed malignancy, of whom 26 had carcinoma in situ. In 13 of the 63 patients (20.6%, 95% CI 11.5-32.7) recurrence was seen only with blue light flexible cystoscopy (p <0.0001). Five of these cases were confirmed as carcinoma in situ. Operating room examination confirmed carcinoma in situ in 26 of 63 patients (41%), which was detected only with blue light cystoscopy in 9 of the 26 (34.6%, 95% CI 17.2-55.7, p <0.0001). Blue light cystoscopy identified additional malignant lesions in 29 of the 63 patients (46%). The false-positive rate was 9.1% for white and blue light cystoscopy. None of the 12 adverse events during surveillance were serious. CONCLUSIONS: Office based blue light flexible cystoscopy significantly improves the detection of patients with recurrent bladder cancer and it is safe when used for surveillance. Blue light cystoscopy in the operating room significantly improves the detection of carcinoma in situ and detects lesions that are missed with white light cystoscopy.
Authors: M C Kriegmair; S Hein; D S Schoeb; H Zappe; R Suárez-Ibarrola; F Waldbillig; B Gruene; P-F Pohlmann; F Praus; K Wilhelm; C Gratzke; A Miernik; C Bolenz Journal: Urologe A Date: 2020-12-10 Impact factor: 0.639
Authors: Ryan M Reyes; Emily Rios; Shane Barney; Cory M Hugen; Joel E Michalek; Yair Lotan; Edward M Messing; Robert S Svatek Journal: Bladder Cancer Date: 2021
Authors: Roger Li; Debasish Sundi; Jingsong Zhang; Youngchul Kim; Richard J Sylvester; Philippe E Spiess; Michael A Poch; Wade J Sexton; Peter C Black; James M McKiernan; Gary D Steinberg; Ashish M Kamat; Scott M Gilbert Journal: Eur Urol Date: 2020-03-04 Impact factor: 20.096