Usefulness of narrow-band imaging in transurethral resection of bladder tumor: Early experience from a tertiary center in India

Abstract

Background: The current standard for diagnosis and treatment of urinary bladder cancer is transurethral resection of bladder tumor (TURBT) using white light guidance. Narrow band imaging (NBI) has emerged as a promising method for identifying additional bladder lesions. Various studies have been published to evaluate its sensitivity in identifying new lesions and its impact on decreasing recurrences. In this study, we evaluated our early experience using NBI in TURBTs. Aims and Objective: The aim of the study is to determine the accuracy of NBI in identifying additional malignant lesions during TURBT. Materials and Methods: We retrospectively collected data for all patients who underwent either TURBT or repeat TURBT with white light and NBI from November 2016 to July 2017 at Cancer Institute (WIA). The number of additional lesions identified using NBI was evaluated along with its correlation with the final histopathology. Results: Forty patients were analysed of which 20 underwent TURBT and 20 underwent repeat TURBT. Of these, 36 patients had complete resection of tumour. Additional lesions were detected in 6 patients (14%) by NBI of which 2 (33%) were malignant histology. The additional lesions detected were carcinoma in situ and no patient was upstaged. Conclusion: The inclusion of NBI to conventional white light TURBT increases the sensitivity for identifying additional lesions. The limitation of NBI is high false positivity and its availability. Long term follow up studies with larger subset of patients are required to evaluate its role in decreasing recurrences and justification in routine clinical practice.

Key words

Narrow-band imaging - nonmuscle invasive bladder cancer - transurethral resection of bladder tumor

• References

• 1 Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2008;54:303-14.
• 2 Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage ta T1 bladder cancer using EORTC risk tables: A combined analysis of 2596 patients from seven EORTC trials. Eur Urol 2006;49:466-5.
• 3 Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
• 4 Gupta P, Jain M, Kapoor R, Muruganandham K, Srivastava A, Mandhani A. Impact of age and gender on the clinicopathological characteristics of bladder cancer. Indian J Urol 2009;25:207-10.
• 5 Dekker E, van den Broek FJ, Reitsma JB, Hardwick JC, Offerhaus GJ, van Deventer SJ, et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy 2007;39:216-21.
• 6 Bryan RT, Billingham LJ, Wallace DM. Narrow-band imaging flexible cystoscopy in the detection of recurrent urothelial cancer of the bladder. BJU Int 2008;101:702-5.
• 7 Li K, Lin T, Fan X, Duan Y, Huang J. Diagnosis of narrow-band imaging in non-muscle-invasive bladder cancer: A systematic review and meta-analysis. Int J Urol 2013;20:602-9.
• 8 Herr HW. Narrow-band imaging cystoscopy to evaluate the response to Bacille Calmette-Guérin therapy: Preliminary results. BJU Int 2010;105:314-6.
• 9 Song PH, Cho S, Ko YH. 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. Cancer Res Treat 2016;48:273-80.
• 10 Cauberg EC, Kloen S, Visser M, de la Rosette JJ, Babjuk M, Soukup V, et al. Narrow band imaging cystoscopy improves the detection of non-muscle-invasive bladder cancer. Urology 2010;76:658-63.
• 11 Naselli A, Introini C, Timossi L, Spina B, Fontana V, Pezzi R, et al. A randomized prospective trial to assess the impact of transurethral resection in narrow band imaging modality on non-muscle-invasive bladder cancer recurrence. Eur Urol 2012;61:908-13.
• 12 Jecu M, Geavlete B, Mulţescu R, Stănescu F, Moldoveanu C, Adou L, et al. NBI cystoscopy in routine urological practice – From better vision to improve therapeutic management. J Med Life 2014;7:282-6.
• 13 Kobatake K, Mita K, Ohara S, Kato M. Advantage of transurethral resection with narrow band imaging for non-muscle invasive bladder cancer. Oncol Lett 2015;10:1097-102.
• 14 Stănescu F, Geavlete B, Georgescu D, Jecu M, Moldoveanu C, Adou L, et al. NBI - plasma vaporization hybrid approach in bladder cancer endoscopic management. J Med Life 2014;7:155-9.
• 15 Ma T, Wang W, Jiang Z, Shao G, Guo L, Li J, et al. Narrow band imaging-assisted holmium laser resection reduced the recurrence rate of non-muscle invasive bladder cancer: A prospective, randomized controlled study. Zhonghua Yi Xue Za Zhi 2015;95:3032-5.
• 16 Kang W, Cui Z, Chen Q, Zhang D, Zhang H, Jin X. Narrow band imaging-assisted transurethral resection reduces the recurrence risk of non-muscle invasive bladder cancer: A systematic review and meta-analysis. Oncotarget 2017;8:23880-90.
• 17 Naito S, Algaba F, Babjuk M, Bryan RT, Sun YH, Valiquette L, et al. The Clinical Research Office of the Endourological Society (CROES) Multicentre Randomised Trial of Narrow Band Imaging-Assisted Transurethral Resection of Bladder Tumour (TURBT) versus conventional white light imaging-assisted TURBT in primary non-muscle-invasive bladder cancer patients: Trial protocol and 1-year results. Eur Urol 2016;70:506-15.
• 18 Dogra PN, Desai P, Singh P. Narrow band imaging cystoscopy in non-muscle invasive bladder cancer – A prospective randomized comparison to the standard white light cystoscopy. J Urol 2016;195:137.