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, Joshua Rabinowitz, Nikhil Vasdev

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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
Number of pages7
JournalBJUI Compass
Volume4
Issue number5
Early online date8 May 2023
DOIs
Publication statusPublished - 23 Aug 2023

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