Impact of enhanced optical techniques at time of transurethral resection of bladder tumour, with or without single immediate intravesical chemotherapy, on recurrence rate of non‐muscle‐invasive bladder cancer: a systematic review and network meta‐analysis of randomized trials

Motlagh, Reza Sari; Mori, Keiichiro; Laukhtina, Ekaterina; Aydh, Abdulmajeed; Katayama, Satoshi; Grossmann, Nico C.; Mostafai, Hadi; Pradère, Benjamin; Quhal, Fahad; Schuettfort, Victor M.; Roshandel, Reza; Karakiewicz, Pierre I.; Teoh, Jeremy Yuen‐Chun; Shariat, Shahrokh F.; Fajković, Harun

doi:10.1111/bju.15383

Cited by 24 publications

(14 citation statements)

References 34 publications

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“…A recent systematic review and network meta‐analysis by Sari et al. sought to also assess whether a single intravesical chemotherapy installation added to the therapeutic effectiveness of BL and narrow‐band‐imaging‐assisted TURBT compared to WL [37]. The findings were consistent with ours in that BL TURBT outperformed WL, and the positive effect was accentuated by intravesical chemotherapy, as one might have expected.…”

Section: Discussionsupporting

confidence: 78%

Blue vs white light for transurethral resection of non‐muscle‐invasive bladder cancer: an abridged Cochrane Review

et al. 2022

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Objectives To assess the effects of blue‐light (BL)‐enhanced transurethral resection of bladder tumour (TURBT) compared to white‐light (WL)‐based TURBT in the treatment of non‐muscle‐invasive bladder cancer (NMIBC). Methods Based on a published protocol, we performed a systematic search of multiple databases from their inception to March 2021. We included randomized controlled trials (RCTs) comparing blue‐light (BL) TURBT to white‐light (WL) TURBT. Our meta‐analysis was based on a random‐effects model. We assessed the quality of evidence on a per‐outcome basis according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results We included 16 RCTs involving a total of 4325 participants in this review. BL TURBT may reduce the risk of disease recurrence over time (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.54–0.81; low‐certainty evidence) depending on baseline risk. For participants with low‐, intermediate‐ and high‐risk NMIBC, this corresponded to 48 (66 fewer to 27 fewer), 109 (152 fewer to 59 fewer) and 147 (211 fewer to 76 fewer) fewer recurrences per 1000 participants when compared to WL TURBT, respectively. BL TURBT may also reduce the risk of disease progression over time (HR 0.65, 95% CI 0.50–0.84; low‐certainty evidence) depending on baseline risk. For participants with low‐, intermediate‐ and high‐risk NMIBC, this corresponded to 1 (1 fewer to 0 fewer), 17 (25 fewer to 8 fewer), and 56 (81 fewer to 25 fewer) fewer progressions per 1000 participants when compared to WL TURBT, respectively. Conclusions Our findings suggest a favourable impact of BL TURBT on the risk of disease recurrence and progression; however, whether this risk reduction is clinically relevant greatly depends on the baseline risk of patients. We did not find an increase in severe surgical complications with BL cystoscopy, and we did not find any trial evidence on other, non‐surgical adverse events.

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Section: Discussionsupporting

confidence: 78%

Blue vs white light for transurethral resection of non‐muscle‐invasive bladder cancer: an abridged Cochrane Review

et al. 2022

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“…A recently published meta-analysis including 4,519 patients by Motlagh et al that focused on enhancement techniques during TURBT in NMIBC found that performing PDD during TURBT with concurrent single immediate intravesical chemotherapy (SIIC) resulted in superior recurrence outcomes. A significant reduction in 12- month recurrence rate performing PDD along with an increase in risk benefit by an additional 32% reduction in odds ratio was noticed when using concomitant SIIC ( 107 ).…”

Section: Resultsmentioning

confidence: 97%

Role of Macroscopic Image Enhancement in Diagnosis of Non-Muscle-Invasive Bladder Cancer: An Analytical Review

Mulawkar

Sharma²,

Tamhankar

et al. 2022

Front. Surg.

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Early diagnosis of non-muscle-invasive bladder cancer (NMIBC) is of paramount importance to prevent morbidity and mortality due to bladder cancer. Although white light imaging (WLI) cystoscopy has long been considered the gold standard in the diagnosis of bladder cancer, it can miss lesions in a substantial percentage of patients and is very likely to miss carcinoma in situ and dysplasia. Tumor margin detection by WLI can be inaccurate. Moreover, WLI could, sometimes, be inadequate in distinguishing inflammation and malignancy. To improve the diagnostic efficacy of cystoscopy, various optical image enhancement modalities have been studied. These image enhancement modalities have been classified as macroscopic, microscopic, or molecular. Photodynamic diagnosis (PDD), narrow band imaging (NBI), and Storz image 1 S enhancement (formerly known as SPIES) are macroscopic image enhancement modalities. A relevant search was performed for literature describing macroscopic image enhancement modalities like PDD, NBI, and image 1 S enhancement. The advantages, limitations, and usefulness of each of these in the diagnosis of bladder cancer were studied. Photodynamic diagnosis requires intravesical instillation of a photosensitizing agent and a special blue light cystoscope system. PDD has been shown to be more sensitive than WLI in the detection of bladder cancer. It is superior to WLI in the detection of flat lesions. Bladder tumor resection (TURBT) by PDD results in more complete resection and reduced recurrence rates. PDD-guided TURBT may have some role in reducing the risk of progression. Narrow band imaging provides increased contrast between normal and abnormal tissues based on neovascularization, thereby augmenting WLI. NBI requires a special light source. There is no need for intravesical contrast instillation. NBI is superior to WLI in the detection of bladder cancer. The addition of NBI to WLI improves the detection of flat lesions like carcinoma in situ. NBI is not useful in predicting invasive tumors or grades of tumors. NBI-directed TURBT reduces recurrence rates and recurrence free survival. But its efficacy in retarding progression is unproven. Image 1 S-enhancement utilizes software-based image enhancement modes without the need for a special light source or intravesical contrast instillation. This system provides high-quality images and identifies additional abnormal-looking areas. Another advantage of this system is simultaneous side-by-side visualization of WLI and enhanced image, providing WLI images as the control for comparison. As with PDD, S-enhancement produces a lower rate of a missed bladder cancer diagnosis. The system significantly improves the diagnosis of NMIBC. The sensitivity and negative predictive value of image 1 S enhancement increase with the increase in cancer grade. A negative test by S-enhancement effectively rules out NMIBC. All the image enhancement modalities have proven their utility in improving detection and short-term cancer control. But none of these modalities have proven their utility in delaying progression, or in long-term cancer control. Cancer progression and long-term control are governed by the biological nature of cancer cells. Early detection by optical enhancement may not be of utility in this regard. Well-designed studies are needed to establish the efficacy of these modalities in the evaluation of patients with bladder cancer. The last word, in this regard, is yet to be written.

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“…Sari Motlagh et al [11 ▪▪ ] in recent systematic review and network meta-analysis included 22 studies with 4519 patients. The goal was to compare the recurrence rates of NMIBC depending on the type of tumour visualization during TURBT (WL vs. PDD vs. NBI) combined with single immediate intravesical chemotherapy (SIIC) administration (administered or not).…”

Section: Meta-analysesmentioning

confidence: 99%

Transurethral resection of bladder cancer with or without fluorescence

Horňák

Brisuda

Babjuk

2023

Current Opinion in Urology

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Purpose of reviewTransurethral resection of bladder cancer (TURBT) is in its standard form an inherently imperfect technique. Fluorescence-guided photodynamic diagnosis (PDD) represents one way to improve the outcome by enhancing tumour detection. Fluorescence has been used in connection with bladder cancer since the 1970s, with a number of studies being published since then. However, the method is still not recommended as a standard part of TURBT mainly because of the limited level of evidence of concerned studies, questionable cost-effectiveness and even contradictory results. The review lists the latest articles covering this topic. Recent findingsSeveral recently published meta-analyses reviewed a series of randomized controlled trials (RCTs) concerning PDD assisted TURBT. Results were generally supporting the positive effect on reduction of recurrence rate. However, the mentioned meta-analyses are overlapping in terms of reviewed RCT that provide only a low level of evidence according to a recent Cochrane review. Supposed limitations of PDD (timing of the procedure, low specificity) and possible solutions are also covered.

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Impact of enhanced optical techniques at time of transurethral resection of bladder tumour, with or without single immediate intravesical chemotherapy, on recurrence rate of non‐muscle‐invasive bladder cancer: a systematic review and network meta‐analysis of randomized trials

Cited by 24 publications

References 34 publications

Blue vs white light for transurethral resection of non‐muscle‐invasive bladder cancer: an abridged Cochrane Review

Blue vs white light for transurethral resection of non‐muscle‐invasive bladder cancer: an abridged Cochrane Review

Role of Macroscopic Image Enhancement in Diagnosis of Non-Muscle-Invasive Bladder Cancer: An Analytical Review

Transurethral resection of bladder cancer with or without fluorescence

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