MP38 FLUORESCENT CYSTOSCOPY WITH HEXAMINOLEVULINATE: DIAGNOSTIC ACCURACY FOR NON MUSCLE INVASIVE BLADDER CANCER A. Volpe, D. Giraudo, I. Zanellato, M. Billia, F. Sogni, P. Mondino, C. Terrone Division of Urology, Maggiore della Carità Hospital, University of Oriental Piedmont, Novara, Italy INTRODUCTION The sensitivity of white light cystoscopy (WLC) can be improved especially for the detection of flat urothelial neoplasms. Fluorescent or blue light cystoscopy (BLC) has the potential to overcome the limitations of WLC. Aim of this study was to compare the diagnostic accuracy of WLC and BLC in the diagnosis of urothelial cancer and to identify the conditions where BLC can provide the highest diagnostic advantage over WLC. PATIENTS AND METHODS 72 patients with suspicious primary or recurrent bladder tumor were enrolled. Patients who had intravesical instillations in the 3 months before the procedure were not eligible. After intravescical instillation of Hexaminolevulinate 85 mg one hour before the procedure, the patients underwent WLC followed by BLC. All observed lesions were reported in a diagram, biopsied or resected. Detection rate and false detection rate of the two techniques were compared. Data were stratified according to pathology of bladder lesions and bladder site where the lesions were observed. A subset analysis was also performed to assess the diagnostic accuracy of WLC and BLC in patients who did (n=37) or did not (n=35) receive previous intravesical treatments. RESULTS 269 bladder lesions were detected (99 with BLC, 8 with WLC, 162 with both techniques). 228 lesions were malignant, 41 were benign. Data on detection rate based on pathology and bladder location are reported in Table 1-2. False detection rate was 10,5% for WLC (18/170) and 13,7% for BLC (36/261). 26/72 patients (36,1%) had a diagnostic advantage with BLC (diagnosis of at least one Cis, dysplastic or papillary lesion missed at WLC). The detection rate of BLC is not decreased in patients who have undergone previous endovesical treatment (97.3% vs. 97,4%), as well as the false detection rate is not increased (13,7% vs 13,6%). WHITE LIGHT CYSTOSCOPY WHITE LIGHT CYSTOSCOPY BLUE LIGHT CYSTOSCOPY GENERAL 67,2% (154/228) 97,3% (222/228) DYSPLASIA 65,5% (19/29) 93,1% (27/29) PUN-LMP 66,1% (45/68) 98,5% (67/68) LG-PUC 78,7% (78/99) 96,9% (96/99) (5/5) HG-PUC 100% (5/5) 100% CIS 16,6% (4/24) 100% (24/24) T1 100% (3/3) 100% Trigon 73,3% (11/15) Right ureteral meatus 83% (5/6) 83% Left ureteral meatus 85% (6/7) 100% (7/7) 71,8% (28/39) 97,4% (38/39) 94,11% Right bladder wall (3/3) Table 1: Detection rate based on pathology BLUE LIGHT CYSTOSCOPY 100% (15/15) (5/6) Left bladder wall 64,7% (11/17) Anterior wall 66,7% (16/24) Posterior wall 75,5% (34/45) 95,5% (43/45) (15/17) Dome 55,5% (35/63) 100% (63/63) Bladder neck 77,7% (7/9) 100% (9/9) Prostatic urethra 100% (1/1) 100% (1/1) 100% (24/24) Table 2. Detection rate based on location CONCLUSIONS BLC is a promising technique that has a significantly higher detection rate than WLC. The highest diagnostic advantage with BLC can be obtained for the diagnosis of Cis and of lesions located at the bladder dome. The detection rate of BLC is not decreased in patients who underwent previous endovesical treatments when the last instillation is not performed in the 3 months before the procedure.