Drejer Ditte, Béji Sami, Munk Nielsen Anna, Høyer Søren, Wrist Lam Gitte, Jensen Jørgen B
a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.
b Department of Urology , Hospital of West Jutland , Holstebro , Denmark.
Scand J Urol. 2017 Apr;51(2):120-123. doi: 10.1080/21681805.2017.1295101. Epub 2017 Mar 7.
This multicenter study investigated whether the use of narrow-band imaging (NBI) in flexible cystoscopy could improve diagnostics to a degree where clinical management was relevantly changed.
From May 2014 to June 2015, 955 patients were enrolled at three Danish urological departments. Patients had either hematuria (n = 483) or known recurrent non-muscle-invasive bladder cancer (NMIBC) (n = 472). High-definition (HD) cystoscopy was performed in white light (WL) and a preliminary clinical decision was made. Then, a second cystoscopy was performed in NBI and a conclusive clinical decision was made. A difference between the two decisions that had a clinical impact on the patient was considered clinically relevant.
Pathology was found in 216 WL cystoscopies, and additional pathology in 15 NBI cystoscopies (6.9%). Based on NBI, pathology was suspected in 23 patients (3.1%) in whom a WL cystoscopy revealed no tumor. In total, NBI changed the clinical decision relevantly in 1.9% of the patients. In hematuria patients, the calculated sensitivities of both NBI and WL were identically high, whereas sensitivity in patients with known NMIBC was significantly higher in NBI compared to WL (NBI: 100.0% vs WL: 83.2%, p < .05). NBI had a lower specificity compared to WL, especially in follow-up cystoscopies (NBI: 86.5% vs WL: 92.1, p < .05).
NBI can be a useful tool in clinical decision making as a supplement to WL because it yields a significantly higher detection rate than WL cystoscopy alone. This is particularly relevant in patients with known recurrent NMIBC.
这项多中心研究调查了在软性膀胱镜检查中使用窄带成像（NBI）是否能将诊断提升至足以对临床管理产生显著改变的程度。
2014年5月至2015年6月，丹麦三个泌尿外科科室招募了955名患者。患者要么有血尿（n = 483），要么有已知的复发性非肌层浸润性膀胱癌（NMIBC）（n = 472）。在白光（WL）下进行高清（HD）膀胱镜检查并做出初步临床决策。然后，在NBI下进行第二次膀胱镜检查并做出最终临床决策。对患者临床有影响的两个决策之间的差异被视为具有临床相关性。
在216次WL膀胱镜检查中发现病理情况，在15次NBI膀胱镜检查中发现额外病理情况（6.9%）。基于NBI，在23名患者（3.1%）中怀疑有病理情况，而WL膀胱镜检查显示这些患者无肿瘤。总体而言，NBI在1.9%的患者中显著改变了临床决策。在血尿患者中，NBI和WL的计算敏感性同样高，而在已知NMIBC的患者中，NBI的敏感性显著高于WL（NBI：100.0% 对 WL：83.2%，p <.05）。与WL相比，NBI的特异性较低，尤其是在随访膀胱镜检查中（NBI：86.5% 对 WL：92.1，p <.05）。
NBI作为WL的补充，可成为临床决策中的有用工具，因为它的检出率明显高于单独的WL膀胱镜检查。这在已知复发性NMIBC的患者中尤为重要。
