NBI Cistoscopy increase the detection rate of Carcinoma in situ; RUAS experience

ABSTRACT
Background: Narrow Banding Imaging (NBI) was developed with the goal of enhancing the
definition of small lesions of the bladder that might be missed during White Light (WL) Endoscopy.
The aim of this study was to evaluate the capacity of NBI to increase the detection rate of lesions
not visible with WL cistoscopy and if we can increase the visibility of Carcinoma in situ (CIS)
Design, setting and participants: From June 2010 to April 2012, 797 patients, underwent to WL
plus NBI cystoscopy and subsequently to Bipolar TURBt. In 797 patients, we identified a total of
1571 suspected lesions, of which 496 (50.6%) were single lesions and 1075 (49.3%), instead,
multiple lesions. The use of cystoscopy with WL has allowed the identification of 1337 lesions.
With the subsequent use of NBI light, we discovered 234 lesions not otherwise visible with WL.
During cistoscopy, were recorded the topography and characterization of lesions by WL and NBI.
All the removed tissue was sent separately for histological evaluation.
We used the logistic regression model in order to identify the relationships between the structural
variables and the ability of the new technique to detect the disease, the indices of sensitivity and
specificity of the test to compare the two techniques, the test of hypothesis Z for the difference in
percentages and the index of relative risk.
Results and limitations: In our experience, the use of NBI significantly increases the ability of WL
cystoscopy in identifying lesions (p<0.05) Using NBI during cystoscopy we found out 234
suspicious lesions not visisble to WL, 127 (12,1%) of those after TURBt resulted in bladder
neoplasms. About this lesions NBI+ WL- 15 was CIS, 12 was a primate lesions and 3 was
recurrence. The charatteristics are resume in tab1
The use of NBI cystoscopy is useful in the identification of CIS lesions. Comparing sensitivity,
specificity, positive predictive value, negative predictive value, of NBI vs WLI Cystoscopy
regarding the CIS lesions, we noted that sensitivity and NPV were the only statistically significant

values (100%, 95% CI, p<005, and 80,62%, 95% CI, 100%,95% CI, p<005, and 78,35%,
respectively).

Conclusions: Bladder cancer remains an important and hard to treat pathology in modern urology,
as it is considered the most expensive tumour with regard either costs per patient per year ot
lifetime costs per patient. Despite the high rate of false positives (35,75%), the overall capacity of
NBI cystoscopy to increase the predictive power to identify suspicious bladder lesions, significantly
increases compared to the use of WL cystoscopy alone. In our experience, the use of NBI
cystoscopy compared to WL Cystoscopy, was particularly useful in the identification of CIS lesions,
showing a sensitivity and a NPV of 100% vs. 80.62% and 100% vs. 78.35%, (p<0.05).
We can conclude that the combination of WL and NBI cystoscopy before TURBt is an economic
and better diagnostic in the bladder tumours and in particolary in the Carcinoma in situ.