Giulianelli Roberto, Gentile Barbara Cristina, Albanesi Luca, Tariciotti Paola, Mirabile Gabriella
C.Ur.A., Urology Department, Nuova Villa Claudia Clinic, Rome.
Arch Ital Urol Androl. 2017 Oct 3;89(3):232-235. doi: 10.4081/aiua.2017.3.232.
The aim of this study was to compare, in order to increase our ability to detect bladder cancer, the predictive power of narrow band imaging (NBI) versus white light cystoscopy (WL). The secondary objective was to evaluate how the preoperative use of NBI cystoscopy can increase the ability to detect bladder lesions in terms of status, multi-focality and dimensions.
Between June 2010 and April 2012, 797 consecutive patients, 423 male and 374 female, affected by suspected bladder cancer lesions, underwent to WL plus NBI cystoscopy and subsequently to WL Bipolar Gyrus PK (Olympus, Tokyo, Japan) transurethral resection of bladder tumour (WL-TURBT). The average follow-up was 24 (16-38) months. Mean age was 67.7 yrs. (range 46-88). All the patients underwent by same surgeon to WL resection (WL-TURBT) of the previously identified lesions by same surgeon. All the removed tissue was sent separately for histological evaluation after mapping the areas of resection on a topographic sheet.
In our study we considered 797 patients that matched our inclusion criteria. Through the use of WL cystoscopy, we identified 603 patients (75.53%) with suspicious lesions, instead, with the use of light NBI, we found 786 patients with suspicious lesions (98.49%).The use of NBI cystoscopy increases by approximately 30% the specific ability to detect lesions not otherwise visible with WL cystoscopy (OR 21.9 and RR 1.30), in particular for patients with lesions size < 3 cm (OR 24.00; RR 1.40), unifocal (OR: 22.28; RR 1.47) and recurrent (OR 58.4; RR 1.34). Pathology demonstrated the presence of cancer in 512 (64.2%) patients, of whom 412 (51.8%) were visible both with WL cystoscopy and NBI cystoscopy. In our experience, only 11 (1.38%) lesions were only positive at WL cystoscopy (negative at NBI cystoscopy) thus 501 (62.8%, OR 10.13; RR 1.21) patients showed bladder oncological lesions positive at NBI cystoscopy. In these patients, the use the NBI Cystoscopy has better highlighted a recurrence (p < 0.005; OR 22.8, RR 1.23; 95% CI-1.13 to 0.24) or a lesion < 3 cm (p < 0.05; OR 11.4 , RR 1.30; 95% CI-0.18 to 0.29) or a unifocal lesion (p < 0.005; OR 10.38, RR 1.34, CI 0.18 to 0.30).
The use of NBI cystoscopy, significantly increases by approximately 30% our predictive power to identify neoplastic lesions, especially unifocal or < 3 cm or recurrent lesions. Following WLTURBT, stage, dimension and focaliity are statistically significant determinants (p < 0.001) of the bladder oncological lesions detected by NBI cystoscopy rather than by WL cystoscopy.
本研究旨在比较窄带成像（NBI）与白光膀胱镜检查（WL）的预测能力，以提高我们检测膀胱癌的能力。次要目的是评估术前使用NBI膀胱镜检查如何在病变状态、多灶性和大小方面提高检测膀胱病变的能力。
2010年6月至2012年4月期间，797例连续患者（423例男性和374例女性）疑似患有膀胱癌症病变，接受了WL加NBI膀胱镜检查，随后进行了WL双极回旋PK（日本东京奥林巴斯公司）经尿道膀胱肿瘤切除术（WL-TURBT）。平均随访时间为24（16 - 38）个月。平均年龄为67.7岁（范围46 - 88岁）。所有患者均由同一位外科医生对先前确定的病变进行WL切除（WL-TURBT）。在将切除区域绘制在地形图上后，所有切除的组织被分别送去进行组织学评估。
在我们的研究中，我们纳入了797例符合纳入标准的患者。通过使用WL膀胱镜检查，我们识别出603例（75.53%）有可疑病变的患者，而使用NBI时，我们发现786例（98.49%）有可疑病变的患者。使用NBI膀胱镜检查使检测WL膀胱镜检查无法发现的病变的特定能力提高了约30%（OR 21.9，RR 1.30），特别是对于病变大小<3 cm（OR 24.00；RR 1.40）、单灶性（OR：22.28；RR 1.47）和复发性（OR 58.4；RR 1.34）的患者。病理检查显示512例（64.2%）患者存在癌症，其中412例（51.8%）在WL膀胱镜检查和NBI膀胱镜检查中均可见。根据我们的经验，仅11例（1.38%）病变仅在WL膀胱镜检查时呈阳性（在NBI膀胱镜检查时为阴性），因此501例（62.8%，OR 10.13；RR 1.21）患者在NBI膀胱镜检查时显示膀胱肿瘤性病变呈阳性。在这些患者中，使用NBI膀胱镜检查能更好地突出复发情况（p<0.005；OR 22.8，RR 1.23；95%CI - 1.13至0.24）或<3 cm的病变（p<0.05；OR 11.4，RR 1.30；95%CI - 0.18至0.29）或单灶性病变（p<0.005；OR 10.38，RR 1.34，CI 0.18至0.30）。
使用NBI膀胱镜检查可使我们识别肿瘤性病变的预测能力显著提高约30%，尤其是单灶性或<3 cm或复发性病变。在WL-TURBT后，分期、大小和灶性是NBI膀胱镜检查而非WL膀胱镜检查检测到的膀胱肿瘤性病变的统计学显著决定因素（p<0.001）。
