Can NBI cystoscopy’s use increase the ability to detect non-muscle invasive bladder neoplasms? PRELIMINARY EXPERIENCE IN A SINGLE CENTRE.

Roberto Giulianelli1, Luca Albanesi1, Francesco Attisani1, Barbara Cristina Gentile1, Luca Mavilla1, Gabriella Mirabile1, Francesco Pisanti1, Giorgio Vincenti1, Manlio Schettini1
  • 1 Nuova Villa Claudia (Roma)

Objective

Bladder cancer remains an important and hard to treat pathology in modern urology, as it is considered the most expensive tumour with regard to both costs per patient per year, as well as lifetime costs for patient. Up to 70% of patients with NMIBC (non-muscle invasive bladder lesions ) will develop a recurrence after the TURBt .
The purpose of this study was to evaluate in our experience how the use of preoperative NBI (NARROW BAND IMAGING) cystoscopy respect to the WL cystoscopy, related to pT and the grading after TURBT, increases our predictive power of identifying non-muscle invasive bladder lesions.

Methods and results

From June 2010 to April 2012, 797 consecutive patients, affected by primitives or recurrences or suspicious non-muscle invasive bladder tumours, underwent WL plus NBI cystoscopy and following to WL Bipolar Gyrus PK TURBT. The average follow-up was at 24 (16-38) months.
Indication about use of TURBt was performed in agreement to the EAU Guideline 2010. The characterization of the sites, including the number, size and appearance of the neoplasms, were recorded on a topographic bladder map. Before we performed a cystoscopy with white light and after with NBI light. All endoscopic resections were performed with an Gyrus PK scalpel, bipolar generator (Olympus, Tokyo, Japan). Resection of each lesion was carried out with white light, whilst a resection of surgical margins was performed along with the bed of surgical resection using only NBI light, which was sent separately with a sequence number identifying them. All histopathological evaluations were performed by a single pathologist based on the 2004 WHO classification.
The follow-up was performed in according to the EAU Guide lines 2010. During the follow-up, all procedures were always performed by the same urologists who had performed the initial TURBT, after the initial assessment of the topographic map where they were shown the location of the tumours detected in white light or in NBI light.

Discussion

In our experience, in 797 patiens, before WL cystoscopy, we observed an overall suspicious bladder lesions detection rate of 75,65% (603 pts.). Following NBI cystoscopy we observed an overall increased suspicious bladder lesions detection rate of 37,89% (190 pts.). Overall false positive detection rate was 35,75% (285 pts.)
In the positive oncological specimens before WL TURBT group, we observed an overall suspicious bladder lesions detection rate by 64,24 % (512 pts), with an overall increased NBI suspicious bladder lesions, visible lesions only before NBI cystoscopies, detection rate by 12,42% (99 pts.) and an overall false positive rate by 11,91 % (95pts).
About to pT (Ta, T1 and CIS) , in WL positive cystoscopy group, with positive oncological specimens following WLTURBT, we observed an overall suspicious bladder lesions detection rate by 65,23% (334 pts). In this group , after NBI cystoscopy we observed an overall suspicious bladder lesions, not visible in WL cystoscopy, increased detection rate by 16,61% (85 pts). In Ta, T1 and CIS groups, following NBI cystoscopy, we observed an increased detection rate of 9,37%, 4,29% and 2,76% respectively.

About to GRADING (PUNMPL, LG, HG), we observed an overall suspicious bladder lesions detection rate 64,24% (512 pts). In this group , before NBI cystoscopy we observed an overall suspicious bladder lesions, not visible in WL cystoscopy, increased detection rate of 19,33% (99 pts). In PUNMPL, LG, HG groups, following NBI cystoscopy, we observed an increased detection rate by 3,32%, 6,83% and 8,78% respectively.

References

NBI cystoscopy increased suspicious bladder lesions, not visible in WL, overall detection rate more in HG lesions (8,78 %, 45 pts) than LG lesions (6,83%, 35 pts). In pT group, NBI cystoscopy increased overall detection rate in pTa, pT1 and CIS pts. about 9,37%, 4,29% and 0,97%, respectively. Regarding to High Risk (H.R.) lesions group (T1HG, CISHG and TaHG) we observed that NBI cystoscopy increased suspicious bladder lesions, not visible in WL , detection rate by 16,20% (35 pts.).

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