Blue light cystoscopy using hexaminolevulinate (HAL) improves detection of bladder cancer compared with white light cystoscopy in a real-world setting.

This study included 533 patients with suspected or known non-muscle-invasive bladder cancer undergoing transurethral resection of the bladder tumour (TURBT) and blue light and white light cystoscopy. Participants were enrolled onto a prospective registry. HAL was instilled into the bladders of participants 1–3 h before TURBT. Cystoscopic examination of the whole bladder was performed using white light and then repeated using blue light. Primary outcomes were sensitivity and specificity of blue light and white light cystoscopy alone and in combination.

In total, 1,632 pathology samples were obtained from 641 blue light cystoscopy procedures. Repeat procedures were performed in 16% of patients. Using final pathology as the reference standard, the sensitivity of white light cystoscopy was 76% and of blue light cystoscopy was 91%; sensitivity of the combination was 99%. Combining blue light cystoscopy with white light cystoscopy increased detection of papillary lesions by 12% and carcinoma in situ by 43%.

An additional 206 lesions were detected in 25% of patients using blue light when the lesions were undectected using white light. Malignant lesions were detected exclusively using blue light in 8% of patients in whom white light found no tumours. Upward migration of American Urological Association risk group occurred in 6% of patients. The total rate of upgrading or upstaging resulting in a change in management using blue light cystoscopy was 14%.

These results show that blue light cystoscopy for detection of bladder cancer is effective in a real-world setting.