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Blue light cystoscopy with Cysview

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An advanced approach to detecting bladder cancer.

Cysview, hexaminolevulinate HCl, is an optical imaging agent used in the cystoscopic detection of nonmuscle invasive papillary bladder cancer.

Used in patients suspected or known to have lesion(s) on the basis of a prior cystoscopy.

Cysview is used with the KARL STORZ D-Light C Photodynamic Diagnostic (PDD) System to perform cystoscopy with the blue-light setting as an adjunct to the white-light setting.

Improves on the use of white-light cystoscopy alone to increase detection of nonmuscular invasive bladder cancer.

Uses a photosensitizer instilled into the bladder for1-3 hours prior to cystoscopy, and improves detection of bladder tumors independent of tumor stage, risk category, and primary or recurrent disease compared with white light cystoscopy.

The improved detection rate is most pronounced in Tis tumors, and improves detection and subsequent treatment leading to a reduction of recurrences at 12 months.

In a multicenter prospective registry study in patients with known or suspected non-muscle invasive bladder cancer white light cystoscope detected 76% of malignant lesions, blue light alone detected 91%, and the two tools together detected 98.5%.

In another trial blue light cystoscopy increased detection of carcinoma in situ and papillary lesions by 43% and 12%, respectively.

Blue light cystoscopy led to a change in the management.

Improves tumor resection, since every tumor detected can be resected in the same TURBT

Does not replace random bladder biopsies or other procedures used in the detection of bladder cancer.

Is not for repetitive use.

The photosensitizing agent preferentially accumulates porphyrins in malignant cells as opposed to nonmalignant cells of urothelial origin.

Itts use compared to white light cystoscopy improves the detection of non-muscle invasive bladder cancer particularly papillary tumors.

Patients diagnosed with bladder cancer and receiving intravesical therapy have a significantly decreased range of recurrence at nine months compared with white light cystoscopy only.

Patient with bladder cancer treated with TURBT with blue light cystoscopy have a decreased rate of recurrence compared with treatment with white light cystoscope.

Photo dynamic diagnosis using blue light to fluorescently visualize a photoactive porphyrin either 5-aminolevulinic acid or hexaainoevuinate hydrochloride instilled  intravesically before TURBT.
Metaanalyses show blue light cystoscopy reduced rates of recurrence but does not affect progression or mortality compared with white light cystoscopy.
 
Blue light cystoscopy is associated with false positives from inflammation, intravesical therapy, and recent instrumentation, reducing its specificity for lesion detection compared with white light cystoscopy.

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