– full guidelines are also available on Urotoday.com.
In this study, TURBT cases completed between 2014 and 2016 at 9 different centers were assessed with WLC first, then underwent BLC evaluation. The reference standard is final pathology at TURBT, though pathology on cystectomy was analyzed separately.
A total of 1632 separate lesions were evaluated from 641 BLC procedures in 531 patients; 85 patients had repeat procedures. In Table 1, they compared the sensitivity of WLC alone, BLC alone and combination in identifying any malignancy, low-grade, high-grade and CIS. Importantly, BLC + WLC improved detection of any malignancy by 22% and detection of CIS by 44%; more modest improvements were noted for low-grade and high-grade disease (13% each). How often did this change the stage? Upstaging was noted in 74 patients (14%).
Overall false positive rate was lower in WLC alone (25% vs. 30%). False positive rate was higher in the 199 patients who received BCG 6 weeks prior to cystoscopy (30%) and the positive predictive value was lower (55%). Similar findings were noted on 95 biopsies done on resections of margins of prior resection sites (PPV 52%, false positive rate 31%). BLC was able to identify 58 malignant lesions n 36 patients who had positive cytology but negative WLC.
In 49 patients undergoing cystectomy, 4 (8%) had lesions only identified with BLC – though they all had WLC and BLC tumors. Overall, it was well tolerated. There was only one episode of hypersensitivity.
As the evidence grows, and as guidelines begin to incorporate it, the use of BLC or similar agents will likely become an important adjunct to WLC. However, cost and time involvement (logistics, requires instillation 1 hour prior to procedure) remain issues that need to be solved.
Presented by: Siamak Daneshmand
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal