Application Of Flexible Cystoscopy And Narrow-Band Imaging In The Diagnosis Of Non-Muscle Invasive Bladder Cancer

Objective To investigate the application value of flexible cystoscopy and narrow-band imaging(NBI)in the diagnosis of non-muscle invasive bladder cancer.Methods Patients who were initially diagnosed as non-muscle invasive bladder cancer in the outpatient department of urology in our hospital from October 2018 to January 2020 were included.All patients were randomly divided into group A and group B.Patients in group A were detected with WLI-cystoscopy plus second look flexible NBI-cystoscopy;Patients in group B were detected with WLI-cystoscopy plus second look WLI-cystoscopy.Two cystoscopy examinations were performed by two two senior doctors with the same proficiency and the same diagnostic level.The location,number and size of tumors observed by cystoscopy before and after were recorded,then all the suspected lesions were biopsied,analysis the difference in the detection rate of non-muscle invasive bladder cancer between two groups of cystoscopy,To evaluate the diagnostic efficacy of flexible.Results A total of 136 patients were included in this study.There were 62patients in group A(WLI-NBI),178 biopsies were taken,124 pathologies were confirmed as pathologically positive and 62 patients with NMIBC were diagnosed.Among them,biopsies were taken from 57 patients in the first examination,133biopsy sites were taken,97 positive lesions were confirmed by pathology,54 cases were diagnosed with NMIBC.In the second examination,additional examinations were taken in 35 cases,and additional examinations were taken in 45 places,27positive lesions were confirmed by pathology,24 patients with positive lesions were detected,and 8 patients were newly diagnosed;There were 67 patients in group B(WLI-WLI),162 biopsies were taken,96 pathologies were confirmed as pathologically positive and 55 patients with NMIBC were diagnosed.Among them,biopsies were taken from 59 patients in the first examination,129 biopsy sites were taken,88 positive lesions were confirmed by pathology,53 cases were diagnosed with NMIBC.In the second examination,additional examinations were taken in 25 cases,and additional examinations were taken in 33 places,8 positive lesions were confirmed by pathology,7 patients with positive lesions were detected,and 2 patients were newly diagnosed.In group A,the detection rate of the first examination was 78.3%(54/69)and the positive rate of lesion biopsy was72.9%(97/133),the detection rate of patients with additional positive lesions in secondary examination was 38.4%(24/69),and the positive rate of lesion biopsy was 60.0%(27/45).The proportion of patients with additional positive lesions detected was 38.7%(24/62),and the proportion of additional positive lesions detected was 21.8%(27/124)in the total number of confirmed patients;In group B,the detection rate of the first examination was 79.1%(53/67),and the positive rate of lesion biopsy was 68.2%(88/129).In group B,the detection rate of patients with additional positive lesions in secondary examination was 10.7%(7/67),and the positive rate of lesion biopsy was 24.2%(8/33).The proportion of patients with additional positive lesions detected was 12.7%(7/55),and the proportion of additional positive lesions detected was 8.3%(8/96)in the total number of confirmed patients.There was no significant difference in the detection rate of the first examination(X~2=0.014,P=0.904)and the positive rate of lesion biopsy(X~2=0.702,P=0.402)between the two groups.The detection rate of patients with additional positive lesions in secondary cystoscopy(X~2=9.613,P=0.02),the positive rate of lesion biopsy(X~2=9.841,P=0.02),the proportion of patients with additional positive lesions detected(X~2=10.103,P=0.01)and the proportion of additional positive lesions detected(X~2=7.307,P=0.07)in group A were all higher than that in group B,and the differences were statistically significant.Further analysis,There were significant differences in the detection rate of multiple tumors(X~2=5.357,P=0.021)and the proportion of single tumors and multiple tumors(X~2=4.003,P=0.045)between group A and group B,There was significant difference in the detection rate of CIS between the two groups.The sensitivity and specificity of NBI cystoscopy were 96.8%and 42.9%.The sensitivity and specificity of WLI cystoscopy were 87.1%and 57.1%respectively.ConclusionNBI flexible cystoscopy can significantly improve the detection rate of NMIBC,which has high application value in the diagnosis of NMIBC;NBI flexible cystoscopy has an obvious advantage in the detection of CIS,which can find more CIS patients;After the first observation with WLI cystoscopy,the second observation with NBI flexible cystoscopy could detect more NMIBC patients and tumor lesions,significantly reducing the rate of missed diagnosis.