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World J Urol. 2018 Oct 26. doi: 10.1007/s00345-018-2537-7. [Epub ahead of print]

Prospective evaluation of the performances of narrow-band imaging flexible videoscopy relative to white-light imaging flexible videoscopy, in patients scheduled for transurethral resection of a primary NMIBC.

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Department of Urology, Frederiksberg/Herlev Hospital, Herlev, Denmark.
Department of Urology, Vestre Viken Baerum Hospital, Drammen, Norway.
Department of Urology, Fundacio Puigvert, Barcelona, Spain.
Department of Urology, Institut Universitaire du Cancer, Toulouse, France.
Department of Biostatistics, Institut Universitaire du Cancer, Toulouse, France.
Department of Urology, Institut Universitaire du Cancer, Toulouse, France.



To evaluate on a lesion-by-lesion basis Narrow-Band Imaging flexible videoscopy (NBI-FV) in the detection of cancer compared to White-Light Imaging flexible videoscopy (WLI-FV).


WLI-FV and NBI-FV were sequentially performed in patients scheduled for TURBT for primary bladder cancer. Suspicious findings were individually harvested and characterized under WLI-FV (suspicious/non-suspicious) and NBI-FV (5-point Likert scale) and pathology. The primary objective was to determine if NBI-FV informed at least 20% more cancer lesions than WLI-FV (Relative true-positive rate > 1.19). A minimum of 120 specimens was to be analyzed to reach 90% power.


Of 147 specimens taken in 68 patients, 101 were found suspicious under WLI-FV and 64 (64/101, 63.4%) confirmed as cancer. Of the 46 lesions undetected by WLI-VF, 16 were found positive for cancer (16/46, 34.8%). For NBI-FV, a significant increase in positive samples was observed with increments in Likert scale (p < 0.0002). Relative true-positive rate was 1.22 (95% CI 1.12-1.39)-NBI-FV detected 22% more cancer lesions compared to WLI-FV. Relative false-positive rate was 1.35 (95% CI 1.19-1.59).


Researching alterations in mucosa and microvasculature by narrow-band imaging flexible videoscopy augmented by 22% the detection of cancer foci and contributed to the objective of complete resection of all visible lesions. Conversely, it entailed a 35% increase in false-positive results compared to white-light imaging, although the structured analysis of narrow-band imaging findings might be used to grade suspicion according to the Likert scale and balance the risk of a false-positive result to the benefit of demonstrating cancer.


Endoscopy; Narrow-band imaging; Sensitivity; Specificity; Urinary bladder neoplasms


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