The Impact of Narrow Band Imaging in the Detection and Resection of Bladder Tumor in Transitional Cell Carcinoma of the Bladder: A Prospective, Blinded, Sequential Intervention Randomized Controlled Trial - 15/05/19

Doi : 10.1016/j.urology.2019.01.039

Partho Mukherjee ^a, Arun Jacob Philip George ^a,^⁎ , Bijesh Kumar Yadav ^b, Lakshmanan Jeyaseelan ^b, Ramani Manoj Kumar ^c, Rajiv Paul Mukha ^a, Jeyachandra Chandrasingh ^a, Santosh Kumar ^a, Nitin S. Kekre ^a, Antony Devasia ^a
^a Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
^b Department of Biostatistics, Christian Medical College, Vellore, India
^c Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India

^⁎Address correspondence to: Arun Jacob Philip George, M.B.B.S., M.S., M.Ch., Department of Urology, Christian Medical College, Vellore, Tamil Nadu 632004, India.Department of UrologyChristian Medical CollegeVelloreTamil Nadu632004India

ABSTRACT

OBJECTIVE

To determine the impact of Narrow Band Imaging (NBI) in detection and resection of tumors during transurethral resection of bladder cancer.

MATERIALS AND METHODS

This was a single center randomized prospective interventional study with a sequential intervention design. Patients with bladder tumors were randomized into 2 arms where they were resected under white light (WL) first followed by NBI in arm A, or NBI followed by WL in arm B. The number of patients in whom additional lesions were detected by the second light source, in both arms, was analyzed. The feasibility of initial resection of tumor under NBI was also studied.

RESULTS

A total of 110 patients were randomized. Of 54 patients in arm A (WL first) additional lesions were identified at the second look in 20 patients (37%). In contrast, of 56 patients in arm B (NBI first), additional lesions were identified in 5(9%) patients. This difference of 28% was statistically significant (P value <.001). In arm B (NBI first), there were 7 breaches in protocol, and all these patients had high risk (more than or equal to 3 in number or 3 cm in size) tumors (P value <.002).

CONCLUSION

Narrowband imaging is superior to WL in the detection of tumors, thus allowing a more complete resection. However, initial resection under NBI is difficult due to poor visibility, especially for high-risk tumors.

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