A meta-analysis of narrow band imaging for the diagnosis and therapeutic outcome of non-muscle invasive bladder cancer.

Yiquan Xiong,Shujuan Ma,Jiandong Li,Jing Ge,Dongliang Li,Lizhi Zhou,Qing Chen,Robert Hurst

doi:10.1371/journal.pone.0170819

Yiquan Xiong, Shujuan Ma + Show 6 more

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https://doi.org/10.1371/journal.pone.0170819

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Journal: PloS one	Publication Date: Feb 13, 2017
Citations: 60	License type: CC BY 4.0

Affiliation: Southern Medical University, Central South University

Abstract

ObjectivesTo assess the additional detection rate (ADR) of within-patient comparisons of Narrow band imaging (NBI) and white light cystoscopy (WLC) for non-muscle invasive bladder cancer (NMIBC) detection and compare the impact of NBI and WLC on bladder cancer recurrence risk.MethodsWe searched relevant studies from PubMed, Embase, Medline, Web of Science and the Cochrane Library database for all articles in English published beforeJuly26th, 2016. Pooled ADR, diagnostic accuracy, relative risk (RR) and their 95% confidence intervals (CIs) were calculated.ResultsTwenty-five studies including 17 full texts and eight meeting abstracts were included for analysis. Compared to WLC, pooled ADR of NBI for NMIBC diagnosis was 9.9% (95% CI: 0.05–0.14) and 18.6% (95% CI: 0.15–0.25) in per-patient and per-lesion analysis, respectively. Pooled ADR of NBI for carcinoma in situ (CIS) diagnosis was 25.1% (95% CI: 0.09–0.42) and 31.1% (95% CI: 0.24–0.39) for per-patient and per-lesion analyses, respectively. The pooled sensitivity of NBI was significantly higher than WLC both at the per-patient (95.8% vs. 81.6%) and per-lesion levels (94.8% vs. 72.4%). In addition, NBI significantly reduced the recurrence rate of bladder cancer with a pooled RR value of 0.43 (95% CI: 0.23–0.79) and0.81 (95% CI: 0.69–0.95) at month three and twelve, respectively.ConclusionsNBI is a valid technique that improves the diagnosis of NMIBC and CIS compared to standard WLC either at per-patient or per-lesion level. It can reduce the recurrence rate of bladder cancer accordingly.

Highlights

Bladder cancer (BC) is the fourth most common malignancy in men and ninth in women [1,2].The incidence of BC is rapidly increasing in underdeveloped countries
Compared to White light cystoscopy (WLC), pooled additional detection rate (ADR) of Narrow band imaging (NBI) for non-muscle invasive bladder cancer (NMIBC) diagnosis was 9.9% and 18.6% in per-patient and per-lesion analysis, respectively
NBI is a valid technique that improves the diagnosis of NMIBC and carcinoma in situ (CIS) compared to standard WLC either at per-patient or per-lesion level

Summary

Introduction

Bladder cancer (BC) is the fourth most common malignancy in men and ninth in women [1,2].The incidence of BC is rapidly increasing in underdeveloped countries. White light cystoscopy (WLC) is the standard imaging tool to identify suspicious lesions, detect cancer and tumor recurrence in bladder. It is difficult to visualize non-papillary bladder cancer using WLC, such as carcinoma in situ (CIS), and small, or satellite tumors[4].In addition, bladder cancer may be incompletely resected because of understaging[5]. These limitations of WLC contribute to the high risk of cancer persistence and high recurrence rate (approximately 61% at year one and 78% at year five) [6,7]. Due to the high prevalence, high recurrence rate, and the need for long-term cystoscopic surveillance, BC has a tremendous impact on healthcare infrastructure and costs[8]

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