Abstract
Simple SummaryBladder cancer is one of the most common malignancies in the United States with a majority of patients diagnosed with non-muscle invasive bladder cancer (NMIBC). Despite early detection and regular surveillance of most cases, recurrence and progression rates remain high. The aim of our systematic review and meta-analysis was to compare the sensitivity, specificity, and oncologic outcomes of photodynamic diagnosis (PDD) fluorescence, narrow band imaging (NBI), and conventional white light cystoscopy (WLC) in detecting NMIBC. Through the collection of prospective and randomized controlled trials, we demonstrated that tumor resection with either PDD and NBI exhibited greater diagnostic sensitivity compared to WLC alone. Our findings underscore the value of integrating these enhanced technologies as a part of the standard care for patients with suspected or confirmed NMIBC.Despite early detection and regular surveillance of non-muscle invasive bladder cancer (NMIBC), recurrence and progression rates remain exceedingly high for this highly prevalent malignancy. Limited visualization of malignant lesions with standard cystoscopy and associated false-negative biopsy rates have been the driving force for investigating alternative and adjunctive technologies for improved cystoscopy. The aim of our systematic review and meta-analysis was to compare the sensitivity, specificity, and oncologic outcomes of photodynamic diagnosis (PDD) fluorescence, narrow band imaging (NBI), and conventional white light cystoscopy (WLC) in detecting NMIBC. Out of 1,087 studies reviewed, 17 prospective non-randomized and randomized controlled trials met inclusion criteria for the study. We demonstrated that tumor resection with either PDD and NBI exhibited lower recurrence rates and greater diagnostic sensitivity compared to WLC alone. NBI demonstrated superior disease sensitivity and specificity as compared to WLC and an overall greater hierarchical summary receiver operative characteristic. Our findings are consistent with emerging guidelines and underscore the value of integrating these enhanced technologies as a part of the standard care for patients with suspected or confirmed NMIBC.
Highlights
Bladder cancer (BCa) represents one of the most common malignancies diagnosed in both males and females with a projected 2021 incidence of 83,730 and mortality of 17,200 in the United States [1]
We present a comprehensive systematic review and diagnostic metaanalysis comparing the diagnostic accuracy of white light cystoscopy (WLC), narrow band imaging (NBI), and photodynamic diagnosis (PDD) in patients with BCa
Search Strategy and Selection Criteria We identified English-only prospective clinical trials of NBI, PDD, and WLC in bladder cancer through a search of PubMed/MEDLINE, Scopus, and Web of Science with the terms “5- aminolevulinate blue-light cystoscopy” OR “ Hexaminolevulinate blue-light cystoscopy” OR “Narrow band imaging cystoscopy” AND “bladder cancer” (Appendix A)
Summary
Bladder cancer (BCa) represents one of the most common malignancies diagnosed in both males and females with a projected 2021 incidence of 83,730 and mortality of 17,200 in the United States [1]. BCa is typically detected in the early stages, there are significant five-year recurrence and progression rates of 78% and 45%, respectively [3]. Given the high risk of both recurrence and progression, regular cystoscopic surveillance is considered the standard of care following the first transurethral resection of a bladder tumor (TURBT) [4]. TURBT with conventional white light cystoscopy (WLC) is the prevailing method for detecting urothelial tumors [4], WLC has a false-negative rate of 10–20% due to limited lesion visualization [5]. Novel technologies are under development to improve lesion detection, diagnostic accuracy, and prognosis
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