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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.