Introduction & objectives: Non-muscle invasive bladder cancer (NMIBC) is one of the most prevalent cancers, associated with a high recurrence-, but low mortality rate. Numerous surgical procedures through the life-time of those affected makes NMIBC an expensive cancer to treat, with significant impact on quality of life. Rigid Blue light cystoscopy (BLC) is routinely used in the operating room to allow improved detection of malignant tumors, leading to more complete tumor resection and reduced recurrence rates. Flexible BLC in the out-patient (OP) setting can assist diagnosis and treatment of NMIBC and could improve patient care by reducing therapeutic burden in addition to saving time and cost. The aim of the current study is to evaluate how OP BLC can improve patient management. 

Materials & methods: The Nordic Flexible BLC registry is an ongoing prospective multicenter study initiated to observe the clinical use and explore possible benefits of OP BLC. Data recorded include NMIBC history, cystoscopy findings, treatment performed and further management. The role of OP BLC in follow-up of NMIBC with focus on number of cases that required no further work-up is presented.

Results: To date, a total of 354 patients in follow-up of NMIBC have been included in the study from five participating sites. Patients are predominantly of high (67%) and intermediate (29%) risk categories, according to the EAU risk classification. In these patients, 462 procedures were performed during follow-up, 370 cases showing suspicious lesions. 
A total of 737 lesions were observed, of which 409 (55%) were fulgurated on-site by laser (42%) or diathermia (57%). Biopsies of 319 suspicious lesions confirmed malignancy in 166 lesions, of which 24% were only visible with BLC. In 88% of cases with suspicious lesions, the patient could be spared from a TURBT, of which 32% received intravesical therapy. 

Conclusions: In follow-up of high and intermediate-risk patients, flexible OP BLC helped resolve a substantial amount of cases by complete fulguration on-site or direct referral to intravesical instillation treatment, providing increased efficacy to manage NMIBC and a reduction in surgical burden.

Flexible blue light cystoscopy provides increased efficacy to manage non-muscle invasive bladder cancer in the outpatient clinic