Cancer Res Treat.  2016 Jan;48(1):273-280. 10.4143/crt.2014.190.

Decision Based on Narrow Band Imaging Cystoscopy without a Referential Normal Standard Rather Increases Unnecessary Biopsy in Detection of Recurrent Bladder Urothelial Carcinoma Early after Intravesical Instillation

• Song PH
• Cho S
• Ko YH

• KMID: 2152285
• DOI: http://doi.org/10.4143/crt.2014.190

Abstract

PURPOSE
The purpose of this study was to calculate the operating characteristics of narrowband imaging (NBI) cystoscopy versus traditional white light cystoscopy (WLC) in common clinical scenarios involving suspicion of bladder urothelial carcinoma (UC).
MATERIALS AND METHODS
Sixty-three consecutive patients initially underwent WLC and then NBI in a single session for evaluation of microscopic hematuria (group I, n=20), gross hematuria (group II, n=19), and follow-up for prior UC (group III, n=24), by an experienced urologist. All lesions that were abnormal in contrast with adjacent normal mucosa were diagnosed as positive and biopsied.
RESULTS
Sixty-six biopsies from 47 patients were performed. Pathologic examination showed 17 cases of UC from 21 sites. While the overall sensitivity of NBI was similar to that of WLC (100% vs. 94.1%), the specificity of NBI was significantly lower than that of WLC (50% vs. 86.9%, p < 0.001), particularly in group III (38.9% vs. 88.9%, p=0.004). Based on identification by NBI only, 23 additional biopsies from 18 cases were performed for identification of one patient with UC, who belonged to group III. In this group, to identify this specific patient, 15 additional biopsies were performed from 10 patients. All seven cases with positive findings from NBI within 2 months after the last intravesical therapy were histologically proven as negative.
CONCLUSION
In evaluation for recurrence early after intravesical instillation, the decision based on NBI increased unnecessary biopsy in the absence of an established standard for judging NBI.

Keyword

Narrow band imaging; Urinary bladder neoplasms; Cystoscopy

MeSH Terms

Administration, Intravesical*
Biopsy*
Cystoscopy*
Follow-Up Studies
Hematuria
Humans
Mucous Membrane
Narrow Band Imaging*
Recurrence
Sensitivity and Specificity
Urinary Bladder Neoplasms
Urinary Bladder*

Figure

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  Fig. 1. False-positive and true-positive cases using narrow band imaging (NBI) cystoscope. White light cystoscopy (WLC) (A; counted as negative) and NBI (B; counted as positive) cystoscopic finding of 64-year-old male who was priorly treated with transurethral resection of bladder for urothelial carcinoma of Ta, low grade. He finished his bacillus Calmette–Guérin (BCG) instillation 9 weeks before cystoscopy, and histologic examination revealed chronic inflammation. WLC (C; counted as positive) and NBI (D; counted as positive) cystoscopic finding of 53-year-old male who was treated with prior transurethral resection of bladder for urothelial carcinoma of T1, low grade. He finished his last BCG instillation 8 months prior, and histologic exanimation found Ta, papillary urothelial carcinoma with low malignant potential.

Reference

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