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Fluorescence cystoscopy: the end of biopsies for carcinoma in situ detection?

The present prospective study by Palou et al. [1], conducted in eight Spanish centres, documents the use of hexaminolevulinate fluorescence cystoscopy (FC)-guided bladder tumour resection and biopsies in 283 patients with non-muscle-invasive bladder cancer (NMIBC). It is an inpatient comparison between white-light cystoscopy and FC. The study presents data from routine practice in Spain and the results show an improvement in diagnosis of NMIBC, especially Ta tumours and carcinoma in situ (CIS) with FCguided resections. These results are confirmation of reports in the literature, including a number of randomized controlled trials and a recent large meta analysis [2]. Although the magnitude of the difference between FC and white-light cystoscopy was somewhat lower in the present study, apparently even in normal daily practice the difference was significant. Moreover, as the rate of CIS in Spain is very high, up to 19% in a large Spanish series [3], I can imagine that the use of FC is of specific interest in this country.