To evaluate the role of blue light (BL) cystoscopy in detecting invasive tumors that were not visible on white light (WL) cystoscopy.
Materials and Methods
Using the multi-institutional Cysview registry database, patients who had at least one white light negative/blue light positive lesion with invasive pathology (≥T1) as highest stage tumor were identified. All white light negative/blue light positive lesions and all invasive tumors in the database were used as denominators. Relevant baseline and outcome data were collected.
Of the 3514 lesions (1257 unique patients), 818 (23.2%) lesions were WL negative (WL-)/BL positive (BL+), of those, 55 (7%) lesions were invasive (48 T1,7 T2) (47 unique patients) including 28/55 (51%) de novo invasive lesions (26 unique patients). 21/47 (45%) patients had WL-/BL+ concommitant CIS and/or another T1 lesions. Of 22 patients with WL-/BL+ lesion who underwent cystectomy, high risk pathologic features leading to cystectomy was only visible on BL cystoscopy in 18 (82%) patients. At time of cystectomy, 11/22 (50%) patients showed pathologic upstaging including 4/22 (18%) patients with node positive disease.
A considerable proportion of invasive lesions are only detectable by BL cystoscopy and rate of pathologic upstaging is significant. Our findings suggest an additional benefit of BL cystoscopy in detection of invasive bladder tumors that has implications for treatment approach.