Utility of Blue Light Cystoscopy for Post-BCG Bladder Cancer Recurrence Detection: Implications for Clinical Trial Recruitment and Study Comparisons.

The utility of blue light cystoscopy (BLC) in patients receiving Bacillus Calmette Guerin (BCG) during post-treatment cystoscopy is not well understood. Our objective was to determine if BLC improves recurrence detection in non-muscle invasive bladder cancer (NMIBC) patients undergoing BCG.

Using the prospective multi-institutional Cysview registry (2014-2019), NMIBC patients who received BCG within 1 year prior to BLC were identified. Primary outcomes were recurrences and whether lesions were detected on white light cystoscopy (WLC), BLC, or both. We calculated the percentage of cystoscopies with recurrences that were missed with WLC alone. The cystoscopy-level BLC false positive rate was the proportion of cystoscopies with biopsies only due to BLC suspicious lesions without recurrence.

From 1703 BLCs, 282 cystoscopies were in the analytic cohort. The overall recurrence rate was 45.0% (n=127). With only WLC, 13% (n=16/127) of recurrences would have been missed as 5.7% (n=16/282) of cystoscopies performed had a recurrence only identified with BLC. Among 16 patients with recurrence missed with WLC, 88% (n=14) had CIS. The cystoscopy-level BLC false positive rate was 5% (n=15).

BLC helped detect recurrences after recent BCG that would have been missed with WLC alone. Providers should consider BLC for high-risk patients undergoing BCG, and should discuss the risk of false positives with these patients. As clinical trials of novel therapies for BCG unresponsive disease increase and there are no clear guidelines on BLC use for post-treatment cystoscopies, it is important to consider how variable BLC use could affect enrollment and comparisons of these studies.

The Journal of urology. 2021 Oct 25 [Epub ahead of print]

Meera R Chappidi, Heiko Yang, Maxwell V Meng, Trinity J Bivalacqua, Siamak Daneshmand, Jeffrey M Holzbeierlein, Hristos Z Kaimakliotis, Badrinath Konety, Joseph C Liao, Kamal Pohar, Gary D Steinberg, Jennifer M Taylor, Mark D Tyson, Brian Willard, Yair Lotan, Sima P Porten, Max Kates

Department of Urology, University of California, San Francisco., Division of Urology, University of Pennsylvania., Department of Urology, University of Southern California/Norris Comprehensive Cancer Center., Department of Urology, University of Kansas., Department of Urology, Indiana University School of Medicine., Department of Urology, University of Minnesota., VA Palo Alto Health Care System., Department of Urology, Ohio State University Wexner Medical Center., Department of Urology, New York University., Michael E. DeBakey VA Medical Center, Baylor College of Medicine., Department of Urology, Mayo Clinic Hospital., Lexington Medical Center., Department of Urology, UT Southwestern Medical Center., The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine.