EAU 2018: Accuracy of Fluorescence and Narrow Band Imaging in the Contemporary Management of Bladder Cancer: A Systematic Review with Diagnostic Meta-Analysis

Copenhagen, Denmark (UroToday.com) Fluorescence cystoscopy or narrow band imaging cystoscopy has recently been introduced to better detect bladder cancer during the follow-up. Dr. Russo presented results of a meta-analysis that evaluated the diagnostic accuracy of white light imaging, narrow band imaging or fluorescence cystoscopy for detecting overall bladder cancer at a “per-biopsy” level.

For this systematic review, the authors performed a systematic literature search of Pubmed/MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) databases and the web-site www.ClinicalTrials.gov until May 2017. The research strategy included the terms “5-aminolevulinate (or 5-ALA) blue-light cystoscopy” OR “Hexaminolevulinate (or HAL) blue-light cystoscopy” OR “Narrow band imaging cystoscopy” AND “bladder cancer”. No language restrictions were applied. Dr. Russo included diagnostic accuracy studies that used white light imaging, narrow band imaging or fluorescence cystoscopy for the diagnosis of overall bladder cancer. 

A total of 877 studies were retrieved and 17 studies were included for quantitative analysis with a total of 9001 biopsies. The pooled data showed a sensitivity of 0.93 (95%CI 0.76-0.98) for fluorescence cystoscopy, 0.97 (95%CI 0.91-0.99) for narrow band imaging, and 0.80 (95%CI 0.65-0.90) for white light imaging. Second, they found a pooled specificity of 0.31 (95%CI 0.10-0.63), 0.64 (95%CI 0.48-0.78) and 0.57 (95%CI 0.39-0.74) for fluorescence cystoscopy, narrow band imaging and white light imaging, respectively. The diagnostic odds ratio for fluorescence cystoscopy, narrow band imaging and white light imaging were 6.18, 54.11 and 5.31, respectively. The hierarchical summary receiver operating characteristic showed an accuracy of 0.77 (95%CI 0.73-0.81) for fluorescence cystoscopy, 0.92 (95%CI 0.89-0.94) for narrow band imaging, and 0.75 (95%CI 0.71-0.79) for white light imaging. They did not find statistical difference in comparing diagnostic sensitivity/specificity of narrow band imaging vs. fluorescence cystoscopy (p=0.36) or between fluorescence cystoscopy vs. white light imaging (p=0.06), while a statistical difference was found between narrow band imaging vs. white light imaging (p=0.03).

The authors concluded that based on results of this meta-analysis, fluorescence cystoscopy and narrow band imaging exhibited greater sensitivity respect to white light imaging, while narrow band imaging showed the highest hierarchical summary receiver operating characteristic. However only narrow band imaging showed greater capabilities respect to white light imaging in the sensitivity/specificity analysis.

Presented by: Giorgio I. Russo, MD University of Catania, Catania, Italy

Co-Authors:  Cacciamani G, Stenzl A, Artibani W, Gill I, Morgia G

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark