the use of the NBI cystoscopy can increase the ability to identify non-muscle invasive bladder cancer? PRELIMINARY EXPERIENCE IN A SINGLE CENTRE.

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

Objective

Bladder cancer is a common neoplasm and the transitional cell carcinoma comprising nearly 90% of all primary bladder tumours . 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 per patient. Up to 70% of patients with NMIBC will develop a recurrence after the TURBt .
The aim of this study was to evaluate the efficacy to identify non-muscle invasive bladder cancer by comparing the predictive power of the white light cystoscopy versus NBI cystoscopy

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 TURBt was performed in agreement with the EAU Guideline 2010. All procedures were carried out initially by performing a cystoscopy with white light. The characterization of the sites, including the number, size and appearance of the neoplasms, were recorded on a topographic bladder map. At this a cystoscopy with NBI was carried out to confirm what had been seen in the white light examination, and to report suspicious areas 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. 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

A total of 797 patients were enrolled in this study. In our experience, in 797 patiens, following 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% (194 pts.). Overall false positive detection rate was 35,75% (285 pts.)
In the positive oncological specimens following 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 after NBI cystoscopies, detection rate by 12,42% (99 pts.) and an overall false positive rate by 11,91 % (95pts).

References

Overall, in our experience, in 797 patiens, following 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% (194 pts.). Overall false positive detection rate was 35,75% (285 pts.) .

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