The 2025 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between February 13th and 15th 2025, was host to the Poster Session B: Urothelial Carcinoma. Dr. Alireza Ghoreifi presented Abstract 686: Upstaging and risk migration with blue light cystoscopy for non–muscle-invasive bladder cancer: Results from a prospective multi-center registry.
Dr. Ghoreifi began his presentation by highlighting that blue-light cystoscopy (BLC) is an established technique for diagnosing and surveilling patients with non-muscle-invasive bladder cancer (NMIBC). BLC has been shown to improve detection rates of NMIBC compared to white-light cystoscopy (WLC); however, there is limited data regarding its role in upstaging and/or upgrading in this setting and when used in conjunction with WLC.
The investigators aimed to assess the incidence and characteristics of upstaging and/or risk-group migration in patients undergoing BLC using data from the prospective multi-institutional Cysview Registry between 2014 and 2024.
Patients with NMIBC who underwent transurethral resection of a bladder tumor (TURBT) or biopsy of bladder tumors were identified in the registry. The authors specifically queried for patients in whom malignant lesions were detected exclusively by BLC and those who experienced an upward change in risk category, as defined by the AUA classification (illustrated below).
The clinical features of these patients were subsequently reviewed and are summarized in the table below. Overall, the study cohort involved 2,854 patients, of these, 4,158 underwent TURBTs/ biopsies, informing a total of 6,432 separate pathology samples. The median age, gender distribution and history of smoking was similar between patients who had upstaging vs. risk migration with BLC.
In the upstaging group, a total of 201 patients (7%) had at least one lesion detected exclusively by BLC, with negative WLC results (a total of 335 lesions). These lesions were primarily carcinoma in situ, and the distribution is shown below:
- Carcinoma in-situ (CIS): 145 (43%)
- Low-grade Ta: 53 (16%)
- High-grade Ta: 95 (28%)
- High-grade T1: 37 (11%)
- High-grade T2: 5 (1%)
In terms of risk migration, specifically in patients with multifocal disease, BLC led to AUA risk-group upward migration in 66 patients (2.3%). The total rate of upgrading or upstaging using BLC was 9.3%.
Upgrading/upstaging to low risk (from negative pathology) was reported in 1.2%, to intermediate risk in 2.1%, and to high risk in 6%. This is illustrated in the graphic below. Notably, 35 patients transitioned from having negative WLC to low-grade Ta tumors on BLC, 42 from negative WLC to high-grade Ta, and 124 from negative WLC to having carcinoma in situ (CIS) (n=85), high-grade T1 (n=34), and high-grade T2 (n=5).
Dr. Ghoreifi concluded his presentation with the following messages:
- Using BLC during TURBT/biopsy of bladder tumors results in risk group migration in over 9% of patients with NMIBC.
- This increased detection rate, and the upgrading/upstaging of bladder tumors have a significant impact on patient management, including the initiation of intravesical therapy when it was not initially planned, the duration of intravesical therapy, or the decision to proceed with radical cystectomy in high-risk or muscle-invasive bladder cancer patients.
Presented by: Alireza Ghoreifi, MD, Society of Urologic Oncology (SUO) Fellow at Duke University Department of Urology. Durham, NC, United States.
Written by: Julian Chavarriaga, MD – Urologic Oncologist at Cancer Treatment and Research Center (CTIC) via Society of Urologic Oncology (SUO) Fellow at The University of Toronto. @chavarriagaj on Twitter during the 2025 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, CA, Thurs, Feb 13 – Sat, Feb 15, 2025.
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