ObjectiveTo compare the value of flexible blue‐light cystoscopy (BLC) vs flexible white‐light cystoscopy (WLC) in the surveillance setting of non‐muscle‐invasive bladder cancer (NMIBC).MethodsAll major databases were searched for articles published before May 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. The primary outcome was the accuracy of flexible BLC vs WLC in detecting bladder cancer recurrence among suspicious bladder lesions.ResultsA total of 10 articles, comprising 1634 patients, were deemed eligible for the quantitative synthesis. In the meta‐analysis focusing on the detection of disease recurrence, there was no difference between flexible BLC and WLC (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.82–1.41)]; the risk difference (RD) showed 1% of flexible BLC, corresponding to a number needed to treat (NNT) of 100. In the subgroup meta‐analysis of detection of carcinoma in situ (CIS) only, there was again no significant difference between flexible BLC and WLC (OR 1.19, 95% CI 0.82–1.69), BLC was associated with a RD of 2% (NNT = 50). The positive predictive values for flexible BLC and WLC in detecting all types of recurrence were 72% and 66%, respectively, and for CIS they were 39% and 29%, respectively.ConclusionSurveillance of NMIBC with flexible BLC could detect more suspicious lesions and consequently more tumour recurrences compared to flexible WLC, with a increase in the rate of false positives leading to overtreatment. A total of 100 and 50 flexible BLC procedures would need to be performed to find on additional tumor and CIS recurences, respectively. A risk‐stratified strategy for patient selection could be considered when using flexible BLC for the surveillance of NMIBC patients.

中文翻译：

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蓝光膀胱镜监测非肌层浸润性膀胱癌：荟萃分析

目的比较软式蓝光膀胱镜（BLC）与软式白光膀胱镜（WLC）在非肌层浸润性膀胱癌（NMIBC）监测中的价值。方法根据所有主要数据库检索2023年5月之前发表的文章系统评价和荟萃分析的首选报告项目 (PRISMA) 声明。主要结果是灵活 BLC 与 WLC 在检测可疑膀胱病变中膀胱癌复发方面的准确性。结果 共有 10 篇文章，包括 1634 名患者，被认为符合定量综合的条件。在关注疾病复发检测的荟萃分析中，灵活 BLC 和 WLC 之间没有差异（比值比 [OR] 1.08，95% 置信区间 [CI] 0.82–1.41）]；风险差异 (RD) 显示 1% 的灵活 BLC，对应于需要治疗的数量 (NNT) 100。在癌症检测的亚组荟萃分析中就地仅 (CIS)，灵活 BLC 和 WLC 之间再次没有显着差异（OR 1.19，95% CI 0.82–1.69），BLC 与 2% 的 RD 相关（NNT = 50）。柔性 BLC 和 WLC 在检测所有类型复发方面的阳性预测值分别为 72% 和 66%，对于 CIS 分别为 39% 和 29%。 结论 采用柔性 BLC 监测 NMIBC 可以发现更多可疑病灶，从而提高复发率。与灵活的 WLC 相比，肿瘤复发率更高，假阳性率增加，导致过度治疗。总共需要进行 100 次和 50 次灵活的 BLC 手术才能分别发现额外的肿瘤和 CIS 复发。当使用灵活的 BLC 监测 NMIBC 患者时，可以考虑采用风险分层策略来选择患者。