Comparing Blue-Light and White-Light Cystoscopy for Bladder Cancer Surveillance

What is it about?

The study compares the accuracy of flexible blue-light cystoscopy (BLC) and flexible white-light cystoscopy (WLC) in detecting bladder cancer recurrence among suspicious bladder lesions in the surveillance setting of non-muscle-invasive bladder cancer (NMIBC). A total of 10 articles were deemed eligible for the quantitative synthesis, comprising 1634 patients. The primary outcome was the accuracy of flexible BLC vs WLC in detecting bladder cancer recurrence among suspicious bladder lesions. The meta-analysis focusing on the detection of disease recurrence showed no significant difference between flexible BLC and WLC. The risk difference (RD) showed 1% of flexible BLC, corresponding to a number needed to treat (NNT) of 100. In the subgroup meta-analysis of detection of carcinoma in situ (CIS) only, there was again no significant difference between flexible BLC and WLC. The positive predictive values for flexible BLC and WLC in detecting all types of recurrence were 72% and 66%, respectively, and for CIS they were 39% and 29%, respectively. The study concludes that surveillance of NMIBC with flexible BLC could detect more suspicious lesions and consequently more tumor recurrences compared to flexible WLC, with an increase in the rate of false positives leading to overtreatment. A total of 100 and 50 flexible BLC procedures would need to be performed to find one additional tumor and CIS recurrence, respectively.

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Why is it important?

This research is important because it compares the value of flexible blue-light cystoscopy (BLC) versus flexible white-light cystoscopy (WLC) in the surveillance setting of non-muscle-invasive bladder cancer (NMIBC). The results of this study can help determine the most effective diagnostic method for detecting recurrences of NMIBC, which is crucial for proper management and treatment of the disease. Key Takeaways: 1. Flexible BLC and WLC have similar accuracy in detecting bladder cancer recurrence among suspicious bladder lesions, with no significant difference between the two methods. 2. Flexible BLC may be associated with a higher detection rate of carcinoma in situ (CIS) recurrence compared to WLC, but this was not statistically significant. 3. The use of flexible BLC in the surveillance of NMIBC patients could lead to an increase in the rate of false positives, resulting in overtreatment. 4. A total of 100 and 50 flexible BLC procedures would need to be performed to find one additional tumor and CIS recurrence, respectively, compared to WLC. 5. A risk-stratified strategy for patient selection could be considered when using flexible BLC for the surveillance of NMIBC patients.