Capacity of the NBI cystoscopy to increase the predictive power to identify suspicious bladder lesions compared to the use of the cystoscopy in white light. RUA’s experience

==inizio abstract==


The aim of this study was to evaluate, in the same patient before WL TURBT, the probability to increase our ability to detect bladder cancer comparing the predictive power NBI visible lesions cystoscopy versus white light visible lesions cystoscopy.


From June 2010 to April 2012, 797 consecutive patients, affected by suspected bladder cancer lesions, were underwent to WL plus NBI cystoscopy and subsequently to WL Bipolar Gyrus PK TURBT. All patients underwent preoperative white light cystoscopy: topography and characterization of neoplasms and/or suspicious lesions followed by a similar evaluation using NBI. Subsequently all the patients underwent WL resection (WLTURBT) of the previously identified lesions.

we observed an overall suspicious bladder lesions detection rate equal to 1571 bladder lesions. Overall, we identified 234 patients with visible lesions only at NBI light. After the WLTURBT, we observed 1051 neoplastic lesions of the bladder; among them 532 were negative. We observed 127 bladder neoplasms in 99 patients, with negative WLI and positive NBI cystoscopy .
The use of WL and NBI cystoscopy allowed us to have a sensibility of 80,66% and of 97,85% , respectively. Regarding the accuracy, we observed a 63,74% and a 62,86% respectively. Staging (CIS, p<0,05), grading (LG, p<0,05), focality (unifocal, p<0,05) and dimensions (< 3cm, <0,05) were statistically significant too. CONCLUSION After NBI cystoscopy, we observed an overall increased suspicious bladder lesions detection rate by 24,34% and a bladder tumours NBI positive detection rate by 12,1%. Overall false positive detection rate was 35,7%. The combination of white light and NBI cystoscopy and subsequently bipolar TURBt seems to allow a better diagnostic and therapeutic approach to bladder tumours, especially in CIS lesions, LG lesions, primitive, unifocals and <3cm lesions. The high rate of false positives could depend on artefacts produced during white light endoscopy. ==fine abstract==