title: Initial experience of combined use of photodynamic diagnosis and narrow band imaging for detection of flat urothelial lesion.
abstract: BACKGROUND
  This preliminary study is the first report to compare photodynamic diagnosis (PDD) with narrow band imaging (NBI) in the same patients with flat urothelial lesions suspicious of carcinoma in situ (CIS) of the bladder.
  
  
  METHODS
  Between November 26, 2012 and April 1, 2013, 10 patients underwent transurethral resection of bladder tumor using PDD and NBI simultaneously because of suspicion of CIS. The bladder was mapped first under white light (WL), then under NBI, and subsequently under blue light in odd-numbered patients. The bladder was mapped first under WL, then under blue light, and subsequently under NBI in even-numbered patients. Biopsies were carried out from all suspicious areas, noting whether NBI, PDD or both detected lesions. Random cold cup biopsies from healthy mucosa of bladder were performed from lesions negative on PDD and NBI.
  
  
  RESULTS
  The sensitivity and specificity of PDD for detection of CIS and dysplasia were 0.916 and 0.827, respectively. The sensitivity and specificity of NBI for detection of CIS and dysplasia were 0.625 and 0.879. The area under the curve (AUC) for detection of CIS and dysplasia was 0.872 with PDD and 0.752 with NBI. The AUC with combined use of PDD and NBI was 0.918. There was no cancer or dysplasia identified in 43 lesions that were both PDD- and NBI-negative.
  
  
  CONCLUSIONS
  When both PDD and NBI are negative, the possibility of CIS or dysplasia might be very low. The usefulness of the combination of PDD with NBI was suggested in this study.
authors.affiliation: Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan, ynaya@koto.kpu-m.ac.jp.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Naya
authors.forename: Masakastu
authors.initials: M
authors.lastname: Oishi
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Yamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Ueda
authors.forename: Atsuko
authors.initials: A
authors.lastname: Fujihara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakanishi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Naito
authors.forename: Terukazu
authors.initials: T
authors.lastname: Nakamura
authors.forename: Fumiya
authors.initials: F
authors.lastname: Hongo
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kamoi
authors.forename: Koji
authors.initials: K
authors.lastname: Okihara
authors.forename: Tsuneharu
authors.initials: T
authors.lastname: Miki
mesh_terms: D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis*; D006801:Humans; D062048:Narrow Band Imaging; D014172:Transillumination; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*; D019459:Urothelium / Q000473:pathology*