The following article is part of conference coverage from the 2018 American Urological Association meeting in San Francisco. Renal and Urology News’ staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2018.
SAN FRANCISCO—Updated results from an ongoing real-world prospective multicenter registry confirm the superior efficacy of blue light cystoscopy with hexaminolevulinate (Cysview) compared with white light cystoscopy in detecting cancerous lesions in patients with non-muscle invasive bladder cancer (NMIBC), according to a presentation at the American Urological Association 2018 annual meeting.
Investigators led by Siamak Daneshmand, MD, Associate Professor of Urology at the University of Southern California (USC) Keck School of Medicine in Los Angeles, studied 755 patients who underwent transurethral resection of bladder tumor (TURBT) for NMIBC from April 2014 to October 2017. Among the 933 patients who underwent TURBT, surgeons identified and resected 2268 separate lesions.
For the detection of any malignancy, the sensitivity of blue light cystoscopy (BLC) with hexaminolevulinate (Cysview) was significantly higher than that of white light cystoscopy (WLC): 91% vs 78%, Dr Daneshmand reported. The improved detection rate was more pronounced for flat lesions (BLC 91% vs WLC 64%).
The positive predictive value (PPV) for BLC and WLC was 66% and 68%, respectively, and the combination of BLC and WLC had a 99% sensitivity for detecting malignant lesions. BLC had greater sensitivity than WLC for all topographic regions of the bladder. In addition, 22% of lesions were diagnosed with BLC alone. Twenty-nine patients (4%) underwent radical cystectomy, as a result of BLC findings. The number needed to screen with BLC for the diagnosis of an additional malignant lesion was 5.
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In an interview with Renal & Urology News, Dr Daneshmand, Director of Urologic Oncology and Director of Clinical Research at the USC Norris Comprehensive Cancer Center, said the new study extends the findings of previous clinical trials—which included patients meeting selective enrollment criteria—to real-world patients. The study included essentially unselected NMBIC patients from 10 centers in the United States. Also, for the first time, researchers demonstrated that the improved sensitivity of BLC over WLC is independent of lesion location with the bladder, and BLC improved identification of tumor progression by 14%.
The FDA approved hexaminolevulinate in 2010 for use in the cystoscopic detection of NMIBC in patients suspected or known to have lesions on the basis of prior cystoscopy. In February, the FDA approved the use of hexaminolevulinate with flexible cystoscopes.
Pearce S, Bateni Z, Bazargani S, et al. Blue light cystoscopy improves detection rates for urothelial bladder cancer compared to white light cystoscopy: Updated results from a prospective multicenter registry. Data presented in poster format at the American Urological Association 2018 annual meeting in San Francisco, May 18–21. Abstract: MP08-17.