STOCKHOLM, SWEDEN (UroToday.com) - White-light (WL) cystoscopy is the most commonly used procedure for the diagnosis of bladder cancer.
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However, given the inability of standard cystoscopy to detect all tumors, narrow-band imaging (NBI) is a developing diagnostic approach for the detection of non-muscle invasive bladder cancer (NMIBC). NBI utilizes an optical filter technology to improve display of superficial capillaries and subepithelial vessels, and unlike photodynamic diagnosis (PDD) does not require administration of a sensitization agent. Dr. Doehn and colleagues presented data from a multicenter, phase-III trial of NMIBC detection using NBI, WL cystoscopy, and PDD at the 2014 EAU meeting in Stockholm.
Two-hundred twenty patients with suspicious cytology, history of bladder cancer, and/or hematuria underwent WL, PDD, and NBI in a standardized fashion (the order of testing was randomized). Allocation remained concealed to clinicians, and all suspicious lesions were resected. The primary endpoint was diagnostic sensitivity, while secondary endpoints included diagnostic specificity and positive/negative predictive values. 32.7% of patients were previously diagnosed with NMIBC (mean time since first diagnosis 61.5 months). Among all patients, there was no significant difference in the sensitivity and specificity between NBI and WL cystoscopy. The median difference of detected tumors per patient between NBI and WL was 0. NBI demonstrated no evidence of superiority to standard WL cystoscopy. While two other meta-analyses have demonstrated higher sensitivity of NBI, the randomized order of diagnostic modality used could have contributed to the lack of an observed significant difference, and further studies are needed to define the role of NBI in the diagnosis of NMIBC.
Presented by Christian Doehn at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden
Urologikum Lübeck, Dept. of Urology, Lübeck, Germany
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com