Blue light cystoscopy for detection of invasive bladder tumor: Results from multi-institutional registry

Introduction The role of blue light cystoscopy in increasing detection and decreasing recurrence and possibly progression rates in non-muscle invasive bladder cancer compared to white light cystoscopy is well supported in the literature. Here we evaluated the role of blue light cystoscopy in detecting invasive tumors that were not visible on white light cystoscopy. Methods Using the multi-institutional Cysview registry database, patients who had at least one white light negative/blue light positive lesion with invasive pathology (≥T1) as highest stage tumor were identified. All white light negative/blue light positive lesions and all invasive tumors in the database were used as denominators. Relevant baseline and outcome data were collected. Results A total of 3514 lesions from 1257 unique patients were evaluated. Of all the lesions in the database, 818 (23.2%) lesions were white light negative/blue light positive of which, 7% (55 lesions from 47 unique patients) were invasive. When all the invasive lesions in the database were considered (total of 494 lesions), 11% were white light negative/blue light positive. Of patients with complete follow up in the database (32), 22 (68%) patients underwent radical cystectomy and 11/22 (50%) showed pathologic upstaging including 4/22 (18%) patients with node positive disease. Conclusions A considerable proportion of invasive lesions are only detectable by blue light cystoscopy and rate of pathologic upstaging is significant. Our findings suggest an additional benefit of blue light cystoscopy in detection of invasive bladder tumors that has implications for treatment approach.