AUA 2020: Gender Based Variations in the Detection of Bladder Cancer with Blue Light Cystoscopy: Insights from a Multicenter Registry

( Prior randomized controlled trials have demonstrated that the use of blue light cystoscopy (BLC) is associated with improved detection of both carcinoma-in-situ and papillary bladder tumors. As a result, BLC is recommended for use in patients with a history of non-muscle-invasive bladder cancer (NMIBC) undergoing surveillance or treatment cystoscopy. However, BLC is associated with a meaningful false positive rate of up to 30%. Many of these false-positive findings may be attributable to a variety of benign inflammatory and/or infectious bladder conditions. Thes conditions may be more common in women. To evaluate further the effect of gender on BLC performance, in a moderated poster presentation at the American Urological Association (AUA) 2020 Virtual Meeting, Ashley Alford, MD, and colleagues report on their analysis of the Cysview® registry to examine differences in the false-positive rate and overall sensitivity of BLC between genders.

The Cysview® registry was compiled between April 2014 and September 2018 by collecting demographic and pathologic information from adult patients undergoing transurethral resection of bladder tumor for known or suspected NMIBC. In this analysis, the primary outcome was the detection of any malignancy on final pathology, for which we calculated the sensitivity and specificity of BLC, white light cystoscopy (WLC), and the combination of both BLC and WLC. The false-positive rate was defined as the proportion of biopsies that yielded benign pathology. The proportions of all tumors detected were compared using the McNemar test, and the sensitivity of BLC and WLC between male and female gender was compared using Fisher’s exact test.

Among 911 patients in the Cysview® registry, 2,390 separate transurethral resection of bladder tumor (TURBT) samples were available for analysis. One hundred and fifty-three (16.8%) patients were female.

In both genders, the sensitivity of BLC was significantly higher than that of WLC (86.7% vs 79.5% in women [p=0.036] and 91.1% vs 80% in men [p<0.001]). There was no significant difference in cancer detection rates between men and women using WLC alone (80% vs 79.5%, p=0.85), or with WLC combined with BLC (98.6% vs 98%, p=0.57). However, the cancer detection rate using BLC was significantly greater in men than in women (91.1% vs 86.7%, p=0.035). The false-positive rate for BLC was 33.6% in the overall cohort and was significantly higher in women than men (35.9% vs 28.5%, p=0.008).

While BLC has greater sensitivity for the detection of bladder cancer than WLC regardless of gender, rates of false positives are higher in women.

Presented by: Ashley Alford, MD, Resident of Urology, University of Minnesota, Minneapolis, MN, USA 

Co-Authors: Subodh Regmi, Arveen Kalapara, Siamak Daneshmand, Sima Porten, Kamal Pohar, and Badrinath Konety

Written by: Christopher J.D. Wallis, MD, PhD, Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN, USA, Twitter: @WallisCJD at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27- 28, 2020

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