title: Clinical relevance of narrow-band imaging in flexible cystoscopy: the DaBlaCa-7 study.
abstract: OBJECTIVE
  This multicenter study investigated whether the use of narrow-band imaging (NBI) in flexible cystoscopy could improve diagnostics to a degree where clinical management was relevantly changed.
  
  
  METHODS
  From May 2014 to June 2015, 955 patients were enrolled at three Danish urological departments. Patients had either hematuria (n = 483) or known recurrent non-muscle-invasive bladder cancer (NMIBC) (n = 472). High-definition (HD) cystoscopy was performed in white light (WL) and a preliminary clinical decision was made. Then, a second cystoscopy was performed in NBI and a conclusive clinical decision was made. A difference between the two decisions that had a clinical impact on the patient was considered clinically relevant.
  
  
  RESULTS
  Pathology was found in 216 WL cystoscopies, and additional pathology in 15 NBI cystoscopies (6.9%). Based on NBI, pathology was suspected in 23 patients (3.1%) in whom a WL cystoscopy revealed no tumor. In total, NBI changed the clinical decision relevantly in 1.9% of the patients. In hematuria patients, the calculated sensitivities of both NBI and WL were identically high, whereas sensitivity in patients with known NMIBC was significantly higher in NBI compared to WL (NBI: 100.0% vs WL: 83.2%, p < .05). NBI had a lower specificity compared to WL, especially in follow-up cystoscopies (NBI: 86.5% vs WL: 92.1, p < .05).
  
  
  CONCLUSIONS
  NBI can be a useful tool in clinical decision making as a supplement to WL because it yields a significantly higher detection rate than WL cystoscopy alone. This is particularly relevant in patients with known recurrent NMIBC.
authors.affiliation: a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.|b Department of Urology , Hospital of West Jutland , Holstebro , Denmark.
authors.forename: Ditte
authors.initials: D
authors.lastname: Drejer
authors.affiliation: c Department of Urology , Herlev Hospital , Herlev , Denmark.
authors.forename: Sami
authors.initials: S
authors.lastname: Béji
authors.affiliation: a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Anna
authors.initials: A
authors.lastname: Munk Nielsen
authors.affiliation: d Institute of Pathology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Høyer
authors.affiliation: c Department of Urology , Herlev Hospital , Herlev , Denmark.
authors.forename: Gitte
authors.initials: G
authors.lastname: Wrist Lam
authors.affiliation: a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.|b Department of Urology , Hospital of West Jutland , Holstebro , Denmark.
authors.forename: Jørgen B
authors.initials: JB
authors.lastname: Jensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D003558:Cystoscopy / Q000379:methods*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006417:Hematuria / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D055815:Young Adult
keywords: Flexible cystoscopy; narrow-band imaging; non-muscle-invasive bladder cancer