Surveillance of non‐muscle‐invasive bladder cancer with blue‐light cystoscopy: a meta‐analysis

Abstract

ObjectiveTo 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).MethodsAll 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.ResultsA 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.ConclusionSurveillance 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.