Introduction: Despite the effectiveness of blue light cystoscopy (BLC) in the management of bladder cancer, the adoption of BLC since its approval has been limited. We evaluated the perceived clinical utility of BLC and assessed factors associated with higher perceived utility of BLC.
Methods: This study used a prospective multi-institutional registry of patients with known or suspected noninvasive bladder cancer. Following BLC, urologists assessed their perceived clinical utility of BLC on a 4-point Likert scale. The primary outcome was the perceived clinical utility of BLC as assessed by participating urologists.
Results: A total of 1,702 rigid cystoscopies performed between 2014 and 2019 were evaluated. Of all lesions biopsied 2,285 were identified with both white light and blue light (60.6%), followed by 867 with blue light only (23.0%) and 423 with white light only (11.2%). Among all post-cystoscopy surveys, urologists perceived BLC to be of some utility (38.1%, 648), moderate assistance (25.4%, 432), essential (19%, 324) and no real utility (17.5%, 298). More urologists perceived BLC to be essential in 2019 (28.3%, 30/106) compared to in 2014 (11.5%, 9/78; p=0.006). On multivariable analysis higher perceived utility was associated with more lesions seen only with blue light (LR 4.88, CI 2.27-8.78), malignant pathology on biopsy (LR 3.31, CI 2.10-5.23), and total number of lesions seen with blue light (LR 1.36, CI 1.19-1.55).
Conclusions: The perceived clinical utility of BLC has been increasing over time, particularly among high-volume urologists. Urologists who identify more lesions with BLC than white light cystoscopy perceive BLC to be most clinically useful.
Keywords: cystoscopy; urinary bladder neoplasms.