Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
BJU Int. 2024 Oct;134(4):526-533. doi: 10.1111/bju.16364. Epub 2024 Apr 24.
To compare the value of flexible blue-light cystoscopy (BLC) vs flexible white-light cystoscopy (WLC) in the surveillance setting of non-muscle-invasive bladder cancer (NMIBC).
All major databases were searched for articles published before May 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was the accuracy of flexible BLC vs WLC in detecting bladder cancer recurrence among suspicious bladder lesions.
A total of 10 articles, comprising 1634 patients, were deemed eligible for the quantitative synthesis. In the meta-analysis focusing on the detection of disease recurrence, there was no difference between flexible BLC and WLC (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.82-1.41)]; 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 (OR 1.19, 95% CI 0.82-1.69), BLC was associated with a RD of 2% (NNT = 50). 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.
Surveillance of NMIBC with flexible BLC could detect more suspicious lesions and consequently more tumour recurrences compared to flexible WLC, with a 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 on additional tumor and CIS recurences, respectively. A risk-stratified strategy for patient selection could be considered when using flexible BLC for the surveillance of NMIBC patients.
比较蓝激光膀胱镜（BLC）与白光膀胱镜（WLC）在非肌层浸润性膀胱癌（NMIBC）监测中的价值。
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明，检索所有主要数据库，以获取截至 2023 年 5 月之前发表的文章。主要结局是在可疑膀胱病变中，柔性 BLC 与 WLC 检测膀胱癌复发的准确性。
共有 10 篇文章，包含 1634 名患者，被认为符合定量综合的条件。在侧重于疾病复发检测的荟萃分析中，柔性 BLC 与 WLC 之间没有差异（比值比 [OR] 1.08，95%置信区间 [CI] 0.82-1.41）；风险差异（RD）显示柔性 BLC 占 1%，相应的治疗人数（NNT）为 100。在仅检测原位癌（CIS）的亚组荟萃分析中，柔性 BLC 与 WLC 之间也没有显著差异（OR 1.19，95%CI 0.82-1.69），BLC 与 RD 为 2%（NNT=50）。柔性 BLC 和 WLC 检测所有类型复发的阳性预测值分别为 72%和 66%，而 CIS 的阳性预测值分别为 39%和 29%。
与柔性 WLC 相比，使用柔性 BLC 监测 NMIBC 可检测到更多可疑病变，从而检测到更多肿瘤复发，导致假阳性率增加，从而过度治疗。需要进行 100 次和 50 次柔性 BLC 检查，才能分别发现更多肿瘤和 CIS 复发。在使用柔性 BLC 监测 NMIBC 患者时，可以考虑对患者进行风险分层选择策略。
