BERKELEY, CA (UroToday.com) - According to most of the available literature, non-muscle invasive bladder cancer (NMIBC) continues to represent a challenge for modern urology as far as diagnostics, treatment, and follow-up are concerned. Quite often, small papillary tumors and flat carcinoma in situ (CIS) lesions are not properly visualized during the white light cystoscopy (WLC), thus leading to a substantial increase of the specific recurrence rates. Although narrow-band imaging (NBI) cystoscopy constitutes an increasingly acknowledged and popular diagnostic modality, clinical results clearly confirming its advantages in tumor detection over the standard cystoscopy remained, at least so far, rather scarce in the literature data.
| "...NBI provided a substantial amelioration to postoperative, therapeutic, bladder cancer management, thus creating the circumstances for a better oncologic outcome to be achieved." |
The present trial assessed three major points of interest in NMIBC management: the diagnostic accuracy of NBI cystoscopy by comparison to the standard endoscopic evaluation, the actual impact of this relatively new method from the perspective of additionally found NMIBC lesions/cases, and the treatment changes resulting from these supplementary findings in such patients.
A total of 95 NMIBC-suspected consecutive cases were enrolled in a single-centre prospective clinical analysis based on the presence of hematuria, positive urinary cytology, and/or ultrasound suspicion of bladder tumors. As part of the study protocol, all patients underwent WLC followed by NBI cystoscopy, resulting in separate bladder maps of all WL, and, respectively, NBI-diagnosed lesions. White light transurethral resection of bladder tumors (TURBT) was performed for all lesions visible at standard cystoscopy, while NBI resection was applied for lesions observed in NBI alone. Additionally, at the end of the procedure, NBI cystoscopic control was used for assessing the margins of the resection areas as well as for identifying eventual residual lesions.
As far as the diagnostic accuracy of these two endoscopic alternatives was concerned, the overall NMIBC (96.2% versus 87.2%) and CIS (100% versus 66.7%) patient-detection rates were significantly improved for NBI in comparison to WLC. Moreover, from the perspective of lesion-detection rates, NBI cystoscopy resulted in significantly superior diagnostic accuracy when compared to WLC with respect to CIS (95.2% versus 61.9%), pTa (93.9% versus 85.2%), as well as overall non-muscle invasive bladder tumors (94.8% versus 83.9%).
Additionally, some progress was also encountered in NBI mode concerning the pTa cases (93.9% versus 87.8%) and pT1 tumor (97.4% versus 92.1%) detection rates. However, these results failed to reach statistical significance. The perspective of supplementary NBI findings was further completed by pathologically confirmed positive tumoral margins secondary to white light TURBT, described during the NBI control performed at the end of the procedure in 10.3% of the NMIBC cases.
Overall, additional tumors were diagnosed by NBI cystoscopy in a significantly higher proportion of CIS (55.5% versus 11.1%), pTa (26.5% versus 10.2%), pT1 (30% versus 10%), as well as NMIBC patients in general (30.8% versus 10.3%). As a result of the superior detection properties specific for the NBI mode, the postoperative instillation treatment was improved in a significantly greater number of NMIBC cases (16.7% versus 5.1%). Last, but not least, the rate of false-positive results was, as expected, slightly higher for NBI by comparison to standard cystoscopy (13.6% versus 11.5%), but not in a statistically significant proportion. In light of this clinical analysis, it could be stated that NBI cystoscopy emphasized significantly improved CIS and overall NMIBC cases, as well as lesions-detection rates, by comparison to WLC, together with significantly more pTa tumors, as well as additional positive tumoral margins, secondary to standard TURBT. All-in-all, it was established that supplementary tumors were diagnosed by NBI cystoscopy in a significantly higher proportion of CIS, pTa, pT1, and NMIBC patients, thus leading to a superior intravesical therapy secondary to NBI results.
It could be concluded that this type of diagnostic approach appears to represent a valuable alternative in NMIBC patients, showing significant improvement of tumor visual accuracy as well as detection. Subsequently, NBI provided a substantial amelioration to postoperative, therapeutic, bladder cancer management, thus creating the circumstances for a better oncologic outcome to be achieved.
Written by:
Bogdan Geavlete, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
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