446 Narrow-band imaging (NBI) in flexible cystoscopy improves diagnosis of bladder pathology in the outpatient clinic

446 - Narrow-band imaging (NBI) in flexible cystoscopy improves diagnosis of bladder p... Page 1 of 2

e446 Narrow-band imaging (NBI) in flexible cystoscopy improves diagnosis of bladder pathology in the outpatient clinic 1

Jensen J.B. , Høyer S. 1 2

2

Aarhus University Hospital, Dept. of Urology, Aarhus, Denmark, Aarhus University Hospital, Institute of Pathology, Aarhus, Denmark

INTRODUCTION & OBJECTIVES: Hexaminolevulinate-guided fluorescence cystoscopy is well-recognized to provide a more complete assessment of bladder pathology than standard white-light (WL) cystoscopy. However, PDD is not recommended in flexible cystoscopy in the outpatient clinic because of difficulties associated with taking biopsies and the low cost-effectiveness in patients with a low risk of bladder pathology. In the present study we have evaluated the feasibility and detection rate of another modality using narrow-band imaging (NBI) to enhance contrast in flexible cystoscopy in the outpatient clinic. MATERIAL & METHODS: A total of 52 consecutive patients undergoing flexible cystoscopy in the outpatient clinic were prospectively included in the study. Thirty patients were investigated because of haematuria and 22 patients as part of a control regimen for previous non-muscle invasive bladder cancer (NMIBC). The bladder was first investigated in WL and all visible bladder pathology was noted. Thereafter, the bladder was investigated in NBI where any additional bladder pathology was noted. Patients with bladder pathology underwent subsequent TURBT in the operation theatre. RESULTS: Of the 30 patients investigated because of haematuria, 5 patients had bladder tumours found in WL cystoscopy (2 Ta low grade (LG), 1 Ta high grade (HG), 1 T1, and 1 T2-tumour). In this group, no additional bladder pathology was diagnosed with NBI but demarcation of suspected mucosa was seen more clearly in NBI. Of the 22 patients investigated because of previous NMIBC, 9 patients had recurrent tumours found in WL cystoscopy. In 4 of these patients, additional

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4/7/2012

446 - Narrow-band imaging (NBI) in flexible cystoscopy improves diagnosis of bladder p... Page 2 of 2

e446a findings were made with NBI (3 flat lesions LG and 1 CIS). Of the remaining 13 patients with previous NMIBC, where WL cystoscopy revealed no recurrence, bladder pathology was suspected by NBI in 4 patients (2 flat lesions LG, 1 Ta HG, and one false positive with inflammation only). CONCLUSIONS: NBI in flexible cystoscopy in the outpatient clinic is feasible and detects more bladder pathology than WL cystoscopy alone. Additional findings were predominantly LG lesions in patients with a history of NMIBC. There was a low incidence of false positive findings. Because of no additional costs compared to standard WL cystoscopy once the equipments has been purchased, we recommend the use of NBI in all flexible cystoscopies if possible. Whether NBIguided TURBT can replace hexaminolevulinate-guided fluorescence TURBT is not clarified at present and awaits further studies.

file://F:\RamShankar\April\04-05-12\Cip\Sour\446.html

4/7/2012