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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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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.

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Acknowledgements

Dr Hannah Levy for editorial assistance, Mr Gamot, urology nurse, for his input in the collection of representative NBI and WLI-FV cases.

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Authors and Affiliations

  1. Department of Urology, Frederiksberg/Herlev Hospital, Herlev, Denmark

    Lars Peder Dalgaard

  2. Department of Urology, Vestre Viken Baerum Hospital, Drammen, Norway

    Reza Zare

  3. Department of Urology, Fundacio Puigvert, Barcelona, Spain

    Josep M. Gaya & Joan Palou Redorta

  4. Department of Urology, Institut Universitaire du Cancer, Toulouse, France

    Mathieu Roumiguié & Bernard Malavaud

  5. Department of Biostatistics, Institut Universitaire du Cancer, Toulouse, France

    Thomas Filleron

Authors
  1. Lars Peder Dalgaard
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  2. Reza Zare
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  5. Mathieu Roumiguié
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Contributions

LPD: Protocol development, data collection, RZ: Protocol development, data collection, JMG: Data collection, JPR: Protocol development, data collection, MR: Data collection, TF: Protocol development, data analysis, BM: Protocol development, data collection, data analysis, manuscript writing.

Corresponding author

Correspondence to Bernard Malavaud.

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Conflict of interest

Dalgaard: none, Zare: none, Gaya: none, Joan Palou Redorta: Participation to Olympus Europe advisory board, Mathieu Roumiguié: none, Thomas Filleron: none, Bernard Malavaud: Participation to Olympus Europe advisory board, Honoraria from Olympus Europe for speaking at Symposia.

Research involving human participants

The study was approved by institutional ethics committee and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Dalgaard, L.P., Zare, R., Gaya, J.M. et al. 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. World J Urol 37, 1615–1621 (2019). https://doi.org/10.1007/s00345-018-2537-7

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  • DOI: https://doi.org/10.1007/s00345-018-2537-7

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