Blue-light transurethral resection and biopsy of bladder cancer with hexaminolevulinate: histopathological characteristics and recurrence rates in a single centred, prospective study

Kimberley Chan, Alexander Hampson, John Hayes, Nikhil Vasdev

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction:
Blue light cystoscopy with hexaminolevulinate (HAL) during transurethral resection of bladder cancer (TURBT) has been shown to improve detection, thereby reducing bladder cancer recurrence compared to white light cystoscopy.
Methods:
Single centred, prospective study on 101 patients who underwent blue light cystoscopy between July 2017 - Nov 2020, performed by a single surgeon. Our study was divided into two arms, the primary arm had no prior diagnosis of bladder malignancy (N=41), whilst secondary/re-resection arm had (N=57). 3 patients with non-urothelial bladder cancer were excluded. Patients were followed up for 12 months. Data was collected on biopsy quality, histopathological characteristics, and recurrence. Initial pathology in white-light was compared to blue-light for patients with malignancy on re-resection, analysed with fisher-exact test.
Results:
Of 98 patients, 39 had malignancy in their first blue light TURBT/biopsy: primary arm (10/41,24.4%), secondary arm (29/57,50.9%), with detrusor present in 80.5% and 80.7% respectively. There was 10% carcinoma in-situ (CIS) in primary arm. In the secondary arm, blue light re-resection detected significantly more CIS (41.4% vs 13.8%, p=0.0379) compared to white light with 3.4% upstaged to muscle invasive bladder cancer (G3pT2). Median time to re-resection was 4.2 months. Recurrence rate was 30.0% vs 24.0%, primary vs secondary arm over period of follow up.
Conclusion:
Our data confirms that blue light cystoscopy with HAL provides superior detection and diagnosis of CIS in patients with previous white light cystoscopy.
Original languageEnglish
JournalCurrent Urology
Publication statusSubmitted - 2 May 2022

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