Narrow Band Imaging Cystoscopy Improves the Detection of Non–muscle-invasive Bladder Cancer
Received 28 September 2009; accepted 6 November 2009. published online 10 March 2010. Corrected Proof
Objectives
To determine whether narrow band imaging (NBI) improves detection of non–muscle-invasive bladder cancer over white-light imaging (WLI) cystoscopy.
Methods
We conducted a prospective, within-patient comparison on 103 consecutive procedures on 95 patients scheduled for (re-) transurethral resection of a bladder tumor (84) or bladder biopsies (19) in the Academic Medical Center, Amsterdam (September 2007-July 2009) and in the General Faculty Hospital, Prague (January 2009-July 2009). WLI and NBI cystoscopy were subsequently performed by different surgeons who independently indicated all tumors and suspect areas on a bladder diagram. The lesions identified were resected/biopsied and sent for histopathological examination. Number of patients with additional tumors detected by WLI and NBI were calculated; mean number of urothelial carcinomas (UCs) per patient, detection rates, and false-positive rates of both techniques were compared.
Results
A total of 78 patients had a confirmed UC; there were 226 tumors in total. In 28 (35.9%) of these patients, a total of 39 additional tumors (17.3%) (26pTa, 6pT1, 1pT2, 6pTis) were detected by NBI, whereas 4 additional tumors (1.8%) (1pTa, 1pT1, 2pTis) within 3 patients (2.9%) were detected by WLI. The mean (SD, range) number of UCs per patient identified by NBI was 2.1 (2.6, 0-15), vs 1.7 (2.3, 0-15) by WLI (P <.001). The detection rate of NBI was 94.7% vs 79.2% for WLI (P <.001). The false-positive rate of NBI and WLI was 31.6% and 24.5%, respectively (P <.001).
Conclusions
NBI cystoscopy improves the detection of primary and recurrent nonmuscle invasive bladder cancer over WLI. However, further validation of the technique with comparative studies is required.
aDepartment of Urology, Academic Medical Center, Amsterdam, The Netherlands
bDepartment of Pathology, Medical Center, Amsterdam, The Netherlands
cDepartment of Urology, General Faculty Hospital, 1st Medical Faculty, Charles University, Prague, Czech Republic
dDepartment of Pathology, General Faculty Hospital, 1st Medical Faculty, Charles University, Prague, Czech Republic
Reprint requests: Evelyne C. C. Cauberg, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
ABSTRACT