Systematic review and meta‐analysis of narrow band imaging for non‐muscle‐invasive bladder cancer

Abstract

To assess the effect of narrow band imaging-guided transurethral resection of bladder tumor compared with white light on recurrence rates in non-muscle-invasive bladder cancer. A systematic review of the literature from inception to November 2020 using Medline, EMBASE and CENTRAL was undertaken. Randomized controlled trials comparing transurethral resection of bladder tumor undertaken with narrow band imaging with those undertaken with white light that reported recurrence rates of at least 12 months were included in the analysis. Primary outcomes were recurrence rates at 12 and 24 months. Secondary outcomes were reported adverse effects. A total of 387 abstracts were screened, of which 14 full text identified and three studies included in the meta-analysis (921 patients). Meta-analysis did not show a statistically significant benefit to narrow band imaging at 12 months; risk ratio 0.75 (95% confidence interval 0.50-1.14, P = 0.18, I 2 = 61%). No included studies provided recurrence data beyond 12 months. Adverse effects were reported in one study and no significant difference of complication rate was observed between the two groups. Risk of bias was assessed to be generally low, and grading of recommendations assessment development and evaluations were of high certainty. This meta-analysis of randomized controlled trials shows no difference in recurrence rates using narrow band imaging, although a trend in its favor was identified. Limitations include the varied reporting and administration of adjuvant therapies. Further well-designed trials are required to examine the benefit of this technology.

Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline: 2024 Amendment

“…36,[41][42][43] In a combined analysis of six randomized control trials (RCT's), one systematic review found improved recurrence for NBI plus white light versus white light alone in patients with suspected or confirmed NMIBC (HR: 0.63; 95% CI: 0.45 to 0.89; I 2 [ 53%; 6 RCTs, 1244 patients). 42 The other three systematic reviews found no difference in recurrence with white light versus white light D NBI cystoscopy 36,37,44 The Panel acknowledges that NBI technology is readily available to many clinicians. While not proven to decrease recurrence, there is no evidence of additional risk incurred by patients with its use.…”

Re: Systematic review and meta‐analysis of narrow band imaging for non‐muscle‐invasive bladder cancer

“…We thank Dr G omez-Ospina and Dr Garc ıa-Perdomo for the interesting points raised in their letter to the editor regarding our recent systematic review. 1,2 The main point highlighted was the potential for the methodological selections made within our review to influence decision-making. They cite prior systematic reviews that report more definitive findings than our own, but use a wider range of evidence, including observational studies.…”

Single immediate instillation of chemotherapy is associated with decreased recurrence and progression in patients with high‐risk non‐muscle‐invasive bladder cancer who receive adjuvant induction bacillus Calmette‐Guérin therapy

“…1 NMIBC accounts for 75% of newly diagnosed BCs. 2,3 TURBT and subsequent intravesical instillation of BCG remain the standard of care for preventing recurrence and progression to MIBC in patients with high-risk NMIBC. [4][5][6] However, a significant number of patients experiences recurrence and progression despite adjuvant BCG therapy.…”

“…BC is the ninth most common cancer in the world 1 . NMIBC accounts for 75% of newly diagnosed BCs 2,3 …”