Histopathologic findings in patients who have undergone blue light cystoscopy and bladder biopsy or transurethral resection: A contemporary clinicopathologic analysis of 100 cases

Abstract

Blue light cystoscopy is utilized to assist Urologists highlight potentially malignant -bladder lesions that might otherwise be undetected by standard cystoscopic techniques. There is a paucity of published studies in the literature regarding the histopathologic findings in this setting, especially regarding false positive lesions. A search was performed for patients who underwent blue light cystoscopy at our institution from 2017 to 2021. Clinicopathologic data was obtained. One hundred cases were included in the study. The mean patient age was 69 years (range: 33-97 years), with a male predominance (3.5:1). Of these cases, 69 were malignant lesions. Twenty-nine cases were high grade urothelial carcinoma (UCa), including 17/29 (58.6%) that were non-invasive, 7/29 (24.1%) invasive into lamina propria, and 5/29 (17.2%) invasive into muscularis propria (Detrusor muscle). Twenty-seven cases were non-invasive low grade UCa, 12 cases were urothelial carcinoma in situ, and 1 case was prostatic adenocarcinoma. Thirty-one cases were benign lesions, including 11/31 (35%) inflammation, 4/31 (13%) nephrogenic adenoma, 3/31 (10%) each: therapy related changes; cystitis cystica et glandularis; reactive changes/atypia, 2/31 (7%) foreign body reaction, 1/31 (3%) each: urothelial papilloma, urethral polyp, squamous metaplasia, focal atypia, and biopsy site changes. Although most cases were malignant, a significant number of benign entities (false positives) were also identified. Correlation between the histopathologic and blue light cystoscopy findings could play a critical role in further stratification and management of patients undergoing this procedure, including surveillance protocols.

Keywords: Bladder cancer; Blue light cystoscopy; False positive; Urothelial carcinoma; White light cystoscopy.