Dr. Suzanne Merrill
speaker
74 appearances
1 recordings
1 series
first heard Aug 2024
last heard Aug 2024
Dr. Suzanne Merrill’s voice in public audio — every appearance, attributed to the second.
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Appearances
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.
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
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,
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.
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...
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.
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
none detected in the TRBT.
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.
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.
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.
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,
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?
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.
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