Prospective evaluation of blue-light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer

Yair Lotan, Iftach Chaplin, Hamed Ahmadi, Xiaosong Meng, Sidney Roberts, Sanam Ladi-Seyedian, Aditya Bagrodia, Vitaly Margulis, Solomon Woldu, Siamak Daneshmand

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objectives: To evaluate the utility of blue-light flexible cystoscopy (BLFC) for surveillance of non-muscle-invasive bladder cancer (NMIBC). Patients and Methods: Prospective cohort of consecutive patients who underwent office-based BLFC for NMIBC. Clinical information was collected including cystoscopic findings and pathological data. Results: A total of 322 cases were performed on 190 patients. The mean age was 71 years and 83% were men. The highest stage prior to BLFC was Ta, carcinoma in situ (CIS), T1, and T2 in 45.3%, 18.4%, 30% and 2%, respectively. Prior to BLFC, 16.8%, 60.5%, and 16.8% were low grade (LG), high grade (HG), and CIS, respectively. Intravesical bacille Calmette–Guérin and intravesical chemotherapy were used in 54.2% and 18.4%, respectively. White-light cystoscopy (WLC) and BLFC were both normal in 173 (53.7%) of cases. WLC was normal and BLFC was abnormal in 26 (8%) cases. Of these, 15 had office-based biopsy and cancer was detected in 13 (87%; six CIS, four HG Ta, three LG Ta). Both WLC and BLFC were positive in 83 (25.8%) cases and 33% had additional tumours found. Cancer was found in 27 (75%) of WLC+/BLFC+ who underwent office-based biopsy including 19 LG Ta, six HG Ta, and two CIS. Conclusions: Incorporation of BLFC in clinical practice has potential advantages of finding cancer in cases with normal WLC. BLFC detected additional cancers in 33% of patients with positive WLC and BLFC, which can improve surveillance and performance of office-based biopsy. Further research is needed to determine cost-effectiveness and impact on recurrence rates.

Original languageEnglish (US)
Pages (from-to)108-113
Number of pages6
JournalBJU international
Issue number1
StatePublished - Jan 2021


  • #BladderCancer
  • #blcsm
  • #uroonc
  • blue light flexible cystoscopy
  • cancer detection
  • non-muscle-invasive bladder cancer

ASJC Scopus subject areas

  • Urology


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