Bladder tumor is the 2nd most common type of urological oncology , 75 % were NMIBC , WLI is the cornerstone modality that is used to diagnose , treat , and monitor NMIBC , However multiple cases of tiny papillary growths , CIS have missed. (1)
These patients will present later with recurrence or progression to muscle invasive tumors.
Sensitivity and specificity of WLI had been studied in multiple researches either it's self or by comparing it with other modalities.
The sensitivity and specificity of WLC range from 62% to 84% and 43% to 98%, respectively , multiple studies found high level of recurrence or prediction of missed non resected tumor during 2nd look (2) .
For these causes, the need of other imaging modalities to rise the detection possibility of small growing lesions as it may alter the treatment plan. (3)
Many researchers studied the difference between gold standard WLI and other multiple methods such as PDD, NBI.
Our study is the first to analyze, discuss, and monitor the probable efficacy of SPIES (spectra B) modality, in comparison with WLI.
PDD is one of the modalities that was used in detection of NMIBC , by using certain derivatives which injected before TUR resection . there is an evidence that PDD has certain indications such as : High grade flat lesions , positive cytology for urothelial carcinoma with negative cystoscopic findings , used as a guidence during resection of flat lesions such as carcinoma in situ as this type of lesions are easily missed during WLC (4) .
Senitivity of bladder cancer detection by PDD is higher than WLC (92%, 95%CI: 80–100% vs. 71%, 95%CI: 49–93%) , but its specificity is lower than WLI (57%, 95%CI: 36–79% vs. 72%, 95%CI: 47–96%) (5).
In second TUR biopsy fewer lesions were detected : 4% CIS lesions compared to 28 % , 15% pT1 lesions compared to 35%, and 17% for high‐grade NMIBC compared to 37% were identified in patients who underwent PDD at the time of initial TUR versus conventional WLC respectively (6)
Table () *
Authors Type of study Year Patient Numbers PDD sensitivity WLC sensitivity P – value PDD specificity WLC specificity
Fradet et al (7)
Open label , multicenter within patient phase III study 2006 298 92% ( CIS lesions ) 68 % 82 % ( CIS lesions ) 72 %
Lapini et al (8)
Open label , multicenter within patient phase III study 2012 96 99.1 % 76.8 % 0.0001 36.5 % 30.2 %
Grossman et al
Open label , multicenter within patient phase III study 2007 311 Ta ; 95 %
T1 : 95 % Ta : 86 %
T1 : 83 % 0.0001
0.3 39 % false detection rate 32 % false detection rate
Jeopn et al (9)
Witin patient comparison 1999 62 98 % 58.8 % <0.0001 42.9 %
Jocham et al (9)
Open label , within patient phase III study 2005 146 96 % 77 %
schmidbauer
et al (10)
Prospective controlled , within – patient comparison 2004 211 97 % 78 %
Studies of Fluorescence Cystoscopy
NBI was one of the tested modalities, which have been studied for multiple times against the conventional WLI regarding to tumor recurrence rate after TUR resection of papillary bladder tumors.
Clinical trial by Naselli et al. which compared WLI against NBI in a prospective randomized clinical trial including 223 patients those underwent TUR resection using NBI and WLI . one year recurrence rate was 32.9 % and 51.4 % in NBI and WLI respectively .
( p = 0.0141) . (11)
Herr et al. found similar results as NBI could detect all malignant lesions as compared to WLI ( P = 0.05 ) .
Similar results were reported by Herr et al. who found that NBI identified
all malignant lesions (100%) as compared to WLC (87%, p = 0.05). WLC . (12)
Table () *
Studies of narrow band Image
Authors Type of study Patient numbers Follow up PDD recurrance – free rates WLC recurrance free rates p- Value
Karaolides et al (13)
Randomised 102 14-17.5 months 18 months : 82.5 % 50.6 % 0.0006
Babjuk et al (14)
Prospective 128 24 12 months : 66 %
24 months : 40 % 39 %
28 % 0.008
Filbeck et al (15)
Randomised study 301 24 12 months : 89.6 %
24 months 89.6 %
73.8 %
65.9 % 0.004
Denzinger et al (16)
Randomised to two groups 301 83-86 2years: 88 %
4 years : 85 %
6 years : 79 %
8 years : 71 % 73 %
64 %
54 %
45 % 0.0003
Stenzl et al (17)
Multi- center prospective randomized study 814 9 9 months: 47 % 56 % 0.026
Denzinger et al (18)
Randomized to two groups 191 90 4 years : 91 %
8 years :
80 % 69 %
52 % 0.025
Grossman et al (19)
Prospective randomised study 551 53-55.1 38 % 31.8 % 0.14
Spies is a new imaging modality which has developed for improving vision and detection of bladder tumors , this modality depending on modification of the white light and reducing red colour contrast in the background of the image and highlighting the vascularity of bladder tumors , this techniqe has 4 different sub modalities ( SPECTRA , SPECTRA B , CHROMA , CLARA ) (20) . This study considers to sudy the efficacy of SPIES ( SPECTRA B ) and its value in complete resection of superficial bladder tumors .
We studied its validity in detection of new recurrent lesions in 3 months follow up in the patients who underwent primary resection using WLI or SPIES modes , total number of 160 patients were randomized into WLI and SPIES groups in which both of them underwent 3 month follow up using SPIES mode .
Inpatient follow up for all cases done using Spies mode after 3 months and it showed infield recurrence in 16 patient in WLI arm and 8 patients in SPIES arm , otherwise outfield recurrence was 4 patients in WLI , and 8 patients in SPIES arm with insignificant difference . ( p- value 0.6 ) , 4 patients were diagnosed as muscle invasive and proceeded to radical cystectomy with 2 patients missed follow up .
Both arms in the study showed insignificant defference in the recurrance rate , while SPIES mode detect some additional areas of hyperemia and early lesions due to its efficacy in modification of colors .
All patients in both arms underwent 2nd look TUR after 2 – 6 weeks after primary resection to search for missed or recurrent lesions which could be detected .
2nd look TUR with WLI intially was carried out for all patients for scan of the bladder and we found that 2nd look TURBT using WLI detect about 6/75 cases of missed lesions in WLI arm , while it detect 4/85 lesions in SPIES arm , as well as it detect 10 /75 cases of recurrence in WLI arm and 9 cases of recurrence in SPIES arm . ( p- value = 0.2 ) .
After switching to SPIES ( spectra B ) mode , the same picture seen by WLI were documented in 62 patient in WLI arm and 67 patient in the SPIES arm , while 13 new lesions were detected in WLI and 18 lesions in SPIES arm . ( p- value 0.3 )
This conclude that there was no difference in the patients of two arms during the second look .
Outpatient 1 year follow up of the patient were carried out for detection of recurrence and it showed recurrence in 16 patient in WLI arm and 9 patients in SPIES , this follow up was done using WLI ( p- value 0.08 ).
Mieke T.J. Bus et. al announced the efficacy of SPIES modality in diagnosis of UTUC (20) .
Refrences
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