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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.

Author information

1
Department of Urology, Frederiksberg/Herlev Hospital, Herlev, Denmark.
2
Department of Urology, Vestre Viken Baerum Hospital, Drammen, Norway.
3
Department of Urology, Fundacio Puigvert, Barcelona, Spain.
4
Department of Urology, Institut Universitaire du Cancer, Toulouse, France.
5
Department of Biostatistics, Institut Universitaire du Cancer, Toulouse, France.
6
Department of Urology, Institut Universitaire du Cancer, Toulouse, France. bernard.malavaud@me.com.

Abstract

PURPOSE:

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).

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

KEYWORDS:

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

PMID:
30367204
DOI:
10.1007/s00345-018-2537-7

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