Investigator Perspectives on Emerging Concepts in the Management of Genitourinary CancersBlue light cystoscopy in the initial diagnosis of bladder cancer
2:41 minutes.
TRANSCRIPTION:
DR GOMELLA: One of the very nice areas that has come through the last couple of years is using agents such as blue light cystoscopy using the hexaminolevulinic acid. I think the real benefit of that technology is helping you pick up carcinoma in situ, areas that you would not necessarily see under white light cystoscopy. And that’s really gotten a lot of increased interest in the United States. It’s almost the standard of care in Europe. In fact, when you look at Europe and the United States when it comes to doing blue light cystoscopy, the issue in the United States is that the commercial compound is only approved for 1-time installation, where in Europe you can use it repeatedly. And, actually, in Europe it’s almost become the standard of care for the management of patients with bladder cancer. So right now, we are doing trials in the United States where it’s going to be used in repeated situations. DR LOVE: What do we know about it at this point? DR GOMELLA: So one of our challenges we have with bladder cancer is recurrence. It’s a very high likelihood of having a recurrence. And the question always is, is the recurrence due to implantation or missed tumor? So one of the advances that’s come forward in the last couple of years is known as blue light cystoscopy using a hexaminolevulinic acid. And essentially what this is, this is a compound you put into the bladder about 30 minutes to an hour before you go to the operating room. And then you use a special blue light cystoscopy system that you can flip between white light and blue light. And essentially, the abnormal cells take up the hexaminolevulinic acid and glow pink under the blue light examination. What this allows us to do is to perhaps pick up tumors that you might not otherwise see under blue light cystoscopy, but it’s clear to me one of the biggest strengths of this blue light cystoscopy exam is to pick up areas of carcinoma in situ, which might be very subtle and might not be papillary and might not get your attention. The last thing about it is, in Europe they’ve actually shown that using blue light cystoscopy, you can do a better resection of the bladder tumor, because if you have a glow around the base of your bladder tumor after you’ve done your transurethral resection, you may want to go back and reresect that area and get a more complete resection. So it’s really a very useful tool to us in the management of initial diagnosis, certainly, of bladder cancer. |