Dr. Suzanne Merrill
Appearances
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And overall, this translated looking at really the raw data from this meta-analysis that the rate of recurrence with use of blue light can be reduced by about 11%, and it can certainly prolong the time to recurrence by about seven-ish months. So some pretty impactful evidence behind this technology.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, no, that's a really good point to bring up. You know, I think at least right now, evidence hasn't really kind of panned out, you know, in regards to it. Does it get picked up by more variant histologies such as small cells, such as micropapillary cells? sarcomatoid, which we all know can be seen. It's more rare, but can be seen certainly in the superficial setting.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
These studies, these randomized studies, multi-center perspective in nature that really set this optical imaging agent up for FDA approval and use today didn't really sort out the variant histology, if you will. What we know is that certainly it does get picked up more by more aggressive type lesions like CIS, but can certainly still be used in the low-grade setting.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And as you mentioned, in our superficial bladder cancer, the mixed-grade heterogeneity is up to 30%. And so it's just very important to be able to ensure that we're capturing heterogeneity if you will, the truth about what is in a patient's bladder. Because, for example, with our intermediate risk category of the AUA, that contains patients that are low-grade, okay, as well as high-grade patients.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
But the recommendations for patients that fall in that intermediate risk category is that the provider, you know, should consider intervesicle therapy. Or excuse me, it says it just should consider intervesicle. it doesn't actually recommend as strongly as if you're in the high-risk category to give intervesical therapy.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So it kind of leaves it up to the provider as to whether that patient should go on further with intervesical treatment or not. And the problem with that, if we've misclassified a patient
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
and they actually, for example, have a CIS lesion that we missed, or it was a predominantly low-grade papillary lesion that was visualized, but yet you miss that one smaller high-grade lesion sitting in the back of the bladder, smaller, then that patient might not be placed into the right risk category and therefore not receive the appropriate intervesical treatment going forward.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
No. Very good point. You're right. It is actually 5% is only what is needed within the total specimen volume to deem that patient now is high grade.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, remarkable. Definitely. And, you know, I think that gets at the point, too, when we talk about the logistics of using this technology is that you do want to use technology.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
both white light and blue light together, that you really should kind of not, you know, kind of only resect under blue light, for example, that you do want to use both kind of information gained from when you're doing your cystoscopy under white light, as well as the information gained under blue light. And that's where you're going to get the best accuracy.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, I mean, I guess there's certainly kind of a learning to it. But I think, again, white light is kind of what has been around historically and traditionally. And it's important that blue light again, how this technology works with SysView and this optical imaging agent and that it accumulates most preferential cancer cells.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
It can also accumulate in areas of trauma and areas of inflammation, okay, where you have, again, this kind of increased kind of vascularity and heme biosynthesis taking place and these photoactive porphyrins in high accumulation. So, Ultimately, they've looked at with these pivotal studies kind of what the false positive rate is between, you know, use of blue light and white light.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And there really is not a significant difference between the two. But we do see, again, where the false positives are occurring are occurring at sites of, again, kind of trauma, potentially previous resection sites, especially on the margins. You can see this happen at the areas of scar. Certainly, if there is kind of active inflammation kind of infection is where this can happen.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So it is important to, again, kind of use your judgment compiled together from both the white light and the blue light as to whether or not you decide to take a biopsy, do a full scraping resection.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
No, there shouldn't be. We can certainly talk about the logistics. It's important. But one of the things when you do, you take that patient into the OR, they have the SysView in their bladder still. You evacuate it after either if they come in with the catheter clamped or if they're holding it naturally.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
evacuate it with the catheter, evacuate it with the scope, and then you should actually cycle the bladder with, again, your saline, wash it out, especially if it's sat in the bladder for longer than that recommended dwell time of an hour. It's definitely kind of accumulated more, so the blue light kind of gets a little bit challenging initially unless you cycle the bladder a couple times and look.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
But that white light visualization should not be infringed upon because of that you know, optical imaging agent in there.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, no, I think it's really important just to, you know, lose the headache of something which has to be done before, right, you can do surgery on a patient and right before in that pre-op setting. So I think one, you know, for all our listeners, PhotoCure creates a kit, a SysView kit, and really it has everything in there to mix and instill, okay?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
You do have to provide a separate, or we provide a separate catheter and Eurojet, But everything is in that SysView kit to use in terms of mixing up, et cetera. And so ultimately, we have created kind of a pre-op order form for our nurses. And we had a full run through in pre-op, kind of a learning session before we kind of rolled this out. at my hospital that I work at. And that has worked well.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And so ultimately, the orders get sent and the nurses now know what to do. The consent is already signed before that patient walks into pre-op. So the nurses have no reason by which to carry out your orders going forward. And ultimately, you know, one of the first questions they ask the patient is, you know, can you hold your bladder, you know, for 30 minutes to an hour?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And if they can, then likely we do not leave a catheter in them clamped. We remove it and they hold it. You really want a 60 minute dwell time post installation for the imaging agent to work well. And you don't want to exceed three hours either. And so because there's at least, you know, about 30 minutes of time, you know, to install.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Even back in 2013, there was a meta-analysis of nine studies, which ultimately showed that detection of TA and T1 lesions may be up to 25% greater, okay, with blue light cystoscopy and use of CISFU. than compared to white light.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
get the patient and put this drug in, if you will, everything like that. And then you got 60 minutes of dwell time. Sometimes this does not work best as the first case. So something to think about, or you at least allocate your patient flow to maybe come in a little bit earlier. So you can start on time.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
But then actually stacking these cases, I think, works pretty nicely, gets the nurses into a rhythm in the pre-op area. But ultimately, once the patient has dwelled for that amount of time, then they come back to the OR, you put your scope in. The scopes, again, that we use with SysView are stored scopes. OK, that has the blue light capability. So that's really important.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So your hospital needs to be outfitted with Storz equipment. This cannot be used with Olympus.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
That's correct. And I think we can certainly should talk about this some more in that this, I think for, you know, a lot of providers, a lot of groups out there, again, academic centers, you know, has this been kind of one of the, you know, barriers that's felt when thinking about can I, should I incorporate this technology into
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
into our practice is because if they don't already have Storz equipment, it can be an upfront cost. Can you get into a contract, of course, where you don't have to buy all this equipment upfront? And I will tell you, even nowadays, there are companies that you outsource for lasers, for example.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
These companies are buying this equipment and are going to soon be providing this option just like they do the Thulium laser, for example, to different ASCs or hospitals, et cetera, that do not want to buy this equipment outright. So it is going to become more accessible for hospital systems, again, groups that don't want to invest at the outright.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Not that not that I know of. It's interesting.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, it really it really is. And I think where why these kind of, you know, third party, you know, groups are, you know, again, purchasing this equipment and again, being offering it is because. Actually, patients are now seeking out this technology. I think it's been around for some time. The evidence is backing it. It's now in our guidelines. More providers are using it. The word's getting out.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
It's on or kind of been talked about, described on kind of more national platform organizations that are patient-facing. And so... again, patients are seeking it out.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So I think these companies are getting savvy that they know that it's going to be a used technology and they're going to fit a need where, again, groups might not want to be buying it outright, but they'll use it just like they do these high-priced lasers.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Then you can leave that catheter clamped. No problem. Just like you do for, you know, our intervesical therapy patients who can't hold their bladder. You can always, you know, leave that catheter in, balloon, you know, balloon up. catheter clamped or a plug and it works just well.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So that really is a very important question to have your pre-op nurses ask because certainly you don't want to, again, use this drug, put it in, and then the poor patient has to go to the bathroom the next 15 minutes.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
The data really over time has shown us that blue light is a technology that should be offered to our patients, that it has good enough evidence behind it, that it can impact our patients course of disease and outcome.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, no, good question. No, there's not. And I think an important point to make that these pivotal studies revealed is that there really wasn't a difference in side effects that patients had who had undergone cyst view installation, blue light illumination. compared to those patients who just underwent the white light TRBT.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And another important tidbit to know is, too, that you can certainly still use, I have done it, post-op gemcitabine for patients who you feel that that is still indicated on. You can perform retrograde pylograms. So all that stuff you can still do, really. You can carry out your normal, again, interoperative workflow for that patient as it's dictated by their situation.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Another important point is if you're doing this after you've done intervesical induction therapy in a patient, you do want to wait about that six-week kind of time point as shortening it up, certainly taking them back too soon after intervesical therapy and using blue light. That's where you probably can see more false positives happen.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
When you're shining that blue light, just because of the inflammation where this optical imaging agent is going to accumulate to is not going to be only in cancer cells.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So there, in 2018, Danishman published in Neurologic Oncology some real-world data, which is really helpful to understand, again, you know, outside of the very strict criteria of a randomized trial, you know, how are people using this data and what are the results? And so through a U.S. kind of prospective multi-senator registry, they found that use of blue light
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
can result in a rate of upstaging of about 14%. And how that breaks down is that ultimately 8% of patients were identified with cancerous lesions, whereas with the white light, they were not. Okay, so that stages them to having cancer. And that 6% of patients actually had an increase in that risk status. What we were talking about before, you know, that vulnerable intermediate risk category was,
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Where again, if they were found to have either a high-grade lesion, whereas initial white light resection would have only shown maybe a white low-grade lesion, or they would have found maybe a CIS lesion, then they're popping up into that high-risk category. And therefore, again, would be set on a path of recommended intervesicle therapy after their resection. So really important stuff for sure.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, no, that's a good question for sure. I think the data is more about showing kind of, again, risk migration in the non-muscle invasive categories rather than switching to a kind of T1 to T2 stage, for example. I think it certainly...
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
This technology really has shown us that it is this CIS, which, as we mentioned before, is a very elusive disease under normal, traditional white light capacity. And that ultimately, historically, we've done a very poor job in detecting CIS.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
In 2023, there was a report looking at kind of a cystectomy database and looking at kind of what the path was retrieved from the, you know, whole mound specimen, the cystectomy, compared to what was their, you know, initial, you know, diagnosis from the TRBT preceding the cystectomy. And ultimately, 45% of cases actually missed CIS. So there is CIS in the cystectomy pathology and
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
none detected in the TRBT.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And so that just gives you a hint that, gosh, if we're missing up to 45% of CIS in patients and that those patients would ultimately be, you know, transitioned, you know, up kind of stage in risk status, if you will, to the high risk category, maybe even the very high risk category, we'd be having different conversations with our patients, ultimately setting them on a completely different, probably cancer journey.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, so narrowband imaging is something we can use on our Olympus scopes. I think a majority of people, you know, perform TRBT with Olympus scopes. And so it's a, again, a kind of, if you will, button kind of toggle switch that you can use to transition images.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
to where now we're having kind of blue to green wavelengths, which actually kind of penetrate the superficial layers of the urethelium, allowing better visualization of the microvascular structures. And of course, you know, cancer structures have more microvascular structures to them. So they're going to kind of show a little bit more enhancement under NBI.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, of course. It's a lot more surprising when we're talking to our patients about how common bladder cancer is. So in 2024, it ranks as the fourth most common cancer in men and the sixth most common cancer in the U.S. for both men and women. And so superficial bladder cancer actually comprises of greater than 60% of all our new diagnoses that go on.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
I think the benefits of NBI is that certainly there's no pre-drug. It's just, again, a flip of a switch, a button pushed on the monitor. You can, again, use it during surveillance as well, just with, again, like a button push on the scope. And, you know, what the AUA says here, and I think they're very cognizant of kind of our resources, right? So,
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
They know that NBI technology is more readily available to clinicians than blue light might be. And so they put it out there as a grade C recommendation. You can consider using this to increase detection. decrease recurrence, but they fully acknowledge that really there doesn't appear to be proven evidence that it decreases recurrence, okay?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
But there's really no additional kind of risk incurred by the patient, incurred by the operator using it. But ultimately, with, you know, kind of systematic reviews being done on NBI versus white light, Really, there's only been one that has shown an improved kind of decrease in recurrence with NBI. The other three have shown really no difference in recurrence.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And when people get superficial bladder cancer, the main concern is that there is a high risk of recurrence. And that recurrence in just year one can be as high as 60 percent and obviously escalates going forward in time. So this discussion we're going to have today about diagnosing it, getting the right stage and grade done,
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And fully taking care of it when we go in for that TURBT is absolutely critical for both our patients and getting them on the right track for treatment.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And overall, this translated looking at really the raw data from this meta-analysis that the rate of recurrence with use of blue light can be reduced by about 11%, and it can certainly prolong the time to recurrence by about seven-ish months.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, of course. So really importantly with the risk stratification that our AUA outlines, which is low, intermediate, and high risk, and nowadays we're even talking about a very high risk group that some of us use to really specify patients that are in need of a more comprehensive talk about even entertaining invasive surgery such as cystectomy.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
But what goes into the wrist ratification with patients is specifically the stage, so what we gain from that TRBT in terms of the depth of invasion, and then grade, as well as focality, so multiple tumors, and then the size of the tumor plays a role. For example, if we find CIS in a patient, that automatically, that stage, if you will, escalates the patient to certainly the high-risk group.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And then if we have a couple of features such as CIS, maybe also T1, if they have lymphovascular invasion, then a lot of us are thinking such patients should fit into even a higher escalation risk category, such as a very high risk group. And those are the patients that we're really concerned about, not only in terms of recurrence, but very much progression of disease.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
So as you mentioned, definitely the cornerstone for diagnosis is that TURBT. And use of blue light cystoscopy combined with the optical imaging agent called cyst view, and it has a long kind of generic name or kind of chemistry name to it, which I'm not going to even go into here. But ultimately, you put this agent into the bladder, and it interacts with the heme biosynthetic pathway.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And it accumulates in these photoactive porphyrins. And it is these photoactive porphyrins which preferentially accumulate in malignant cells. And then when we use blue light illumination, it's these photoactive porphyrins that then, okay, which are accumulated in the cancerous cells, fluoresce bright pink, okay, under that blue light illumination. And so you're able to visually see that.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
where these cancerous cells and conglomerations of these cancerous cells are, where they might not be apparent under white light, and really where this optical imaging agent has kind of shined, if you will, to use that. is in carcinoma in situ cases. So where we know that that disease specifically can be elusive under white light, we can miss it.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
This agent really has shown to be uptake specifically in that superficial type of bladder cancer and allows us to visualize it, resect it, even see the margins of our resection to be able to fully resect and evacuate the cancer from the patients at the time of the TRBT.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, no, I think it's an important kind of topic to bring up. And it's certainly one of discussion and one of preference. But I will tell you that when this optical imaging agent rolled out, it was FDA approved in 2010. And so it's been around for quite some time.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And initially, we were using it really in patients that we knew already had a diagnosis of CIS, where it really has shown to detect that cancer, actually showing ultimately that it detects it, just to give you some hard data here, detects CIS tumors were found in 34.6%. patients compared to, for example, white light. The CIS tumors were only found in blue light up to 34.6% of the time.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And so initially people thought, well, maybe I should only use it for CIS patients. And ultimately, right, we only know a patient has CIS after that first TURBT. And so people would use it in that sort of situation. It was also felt to be a good use in people that had that positive cytology, but that white light surveillance cystoscopy didn't show anything abnormal.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And so you could use it there to see if we could see anything better under blue light illuminescence. But really, as we've used this technology more and more, we're finding that it really has more widespread applications. And it can be used for any resection, for any low-grade, high-grade patient or stage of disease.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
I will tell you that when I don't think about using this is in your high volume tumor patients. So where you've gone in there cystoscopically, you know, the first time after the workup and there's just tumor everywhere. You have a hard time seeing normal urethelial walls. It's very hard to navigate kind of around the bladder. that is probably not a great time to use this technology.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
But I can tell you, though, using that technology on that patient for the second resection is a great use to make sure that you've gotten all the tumor out of there, that you can see kind of your margins of resection. You know, I think we've all felt, and I'm sure you can agree, Suzette, that we do not do as good of a job with TRBTs as we think we do, right?
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
We train our residents, you know, very early on with doing TRBTs. Obviously, this is a cornerstone of urology. They need to know how to do them. But many times when we're doing TRBTs, we're with a junior resident, for example. This is kind of the junior resident case.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
And unfortunately, the TRBT is so critically important for these patients as, again, it is one of their mainstays of treatment to get that cancer out fully, accurately stage and grade the patient, get them on that right journey. And there is a lot of data out there and we all know it that we do leave tumor behind.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
There's reports up to, you know, 76% that residual tumor is left behind after the first TRBT. And that's a high number. And so again, this technology can really help to make sure that we do the best job we can for our patients, you know, at those TRBT settings, initial TRBT, repeat TRBTs, and getting all that cancer out that we can.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Yeah, that's very true. I think the data really over time has... shown us that blue light is a technology that should be offered to our patients, that it has good enough evidence behind it, that it can impact our patient's course of disease and outcome.
BackTable Urology
Ep. 186 Blue Light Cystoscopy: Improving Bladder Cancer Detection with Dr. Suzanne Merrill
Even back in 2013, there was a meta-analysis of nine studies, which ultimately showed that detection of TA and T1 lesions may be up to 25% greater with blue light cystoscopy and use of cis-fueled than compared to white light.