How is outpatient blue light cystoscopy used in clinical routine? First results from the Nordic registry
Blue light cystoscopy (BLC) with hexaminolevulinate as an adjunct to white light cystoscopy (WLC) gives higher sensitivity for identifying bladder cancer and reduces recurrence rate compared to WLC alone. BLC is therefore recommended as an adjunct to WLC. Recently BLC with a flexible scope in the outpatient setting has been tested in a randomized prospective study with good results. A Nordic registry study has been initiated to observe the clinical utility and explore possible benefits of BLC in the outpatient setting. This abstract presents the first results of the study on behalf of the Nordic blue light registry investigators, focusing on treatment and patient experience.
The Nordic registry includes patients with suspicion of non-muscle-invasive bladder cancer (NMIBC) or patients in routine follow-up. Hexaminolevulinate (Hexvix/Cysview, Photocure ASA) is instilled in the outpatient department, and the bladder examined with WLC and BLC. Biopsies are taken from suspicious lesions and tumors can be fulgurated on site. Data recorded are patient demographics, bladder cancer history, findings under WLC and BLC, treatment performed, patient preference, physician experience and further patient management.
To date, the study has included 79 NMIBC patients at four hospitals with 92 procedures with BLC as adjunct to WLC in the outpatient setting. Average age was 73 years and 22% were females. Previous history included Ta (61%), T1 (19%) and CIS (23%). In 71% of the procedures, suspicious lesions were treated in the office. In 26% of treated patients, physicians reported that treatment could be completed in the outpatient setting due to BLC, preventing referral to transurethral resection (TURBT). An added value of BLC was reported in 82% of the procedures. In addition to achieving complete treatment in the office, key advantages noted were additional lesions seen (29%) and confidence in recurrence free patient (23%). Treatment in the office was well tolerated. Of patients treated, all but 2 preferred the outpatient procedure compared to a TURBT. In 6 instances, the patient complained about discomfort associated with biopsy or fulguration.
BLC as an adjunct to WLC in the outpatient setting was easy to implement in routine management. It identified additional lesions and allowed more patients to receive complete treatment without referral to TURBT.
Funding: Photocure ASA contributes financially to the registry study