6 augustus 2022: Bron: Front. Surg., 21 February 2022 Sec. Genitourinary Surgery
Een zo vroeg mogelijke diagnose van niet-spierinvasieve blaaskanker is heel belangrijk omdat zodra er sprake is van spierinvasieve blaaskanker dit meestal leidt tot een hoog risico op zeer belastende behandelingen en groot risico op overlijden als gevolg van blaaskanker.
In Frontiers Surgery werd dit jaar een analytische review gepubliceerd van de ontwikkeling van de zogeheten macroscopische beeldvorming. Fotodynamische diagnose (PDD), smalbandbeeldvorming (NBI) en Storz-beeld 1 S-verbetering (voorheen bekend als SPIES) zijn macroscopische beeld verbeterende manieren.
Cystoscopie met wit licht beeldvorming (WLI) werd en wordt nog wel beschouwd als een goede manier bij de diagnose van blaaskanker. Maar de praktijk wijst uit dat bij een aanzienlijk percentage van de patiënten afwijkingen worden gemist en is het zeer waarschijnlijk dat carcinoom in situ en dysplasie worden gemist. Tumormarge detectie door WLI kan onnauwkeurig zijn. Bovendien kan WLI soms ontoereikend zijn in het onderscheiden van ontstekingen en maligniteiten.
In een analytische review, een artikel uit deze reeks van artikelen, uitgevoerd naar literatuur die macroscopische beeldverbeteringsmodaliteiten beschrijft, zoals PDD, NBI en beeld 1S-verbetering worden de voordelen, beperkingen en bruikbaarheid van elk van deze bij de diagnose van blaaskanker onderzocht en beschreven:
- Fotodynamische diagnose vereist intravesicale instillatie van een fotosensibiliserend middel en een speciaal cystoscoopsysteem met blauw licht. Het is aangetoond dat PDD gevoeliger is dan WLI bij de detectie van blaaskanker. Het is superieur aan WLI bij de detectie van platte laesies.
- Blaastumorresectie (TURBT) door PDD resulteert in een meer complete resectie en verminderde recidief percentages. PDD-geleide TURBT kan een rol spelen bij het verminderen van het risico op progressie.
- Narrow-band imaging zorgt voor een verhoogd contrast tussen normale en abnormale weefsels op basis van neovascularisatie, waardoor WLI wordt vergroot. NBI vereist een speciale lichtbron. Er is geen intravesicale contrastinstillatie nodig. NBI is superieur aan WLI bij de detectie van blaaskanker.
- De toevoeging van NBI aan WLI verbetert de detectie van vlakke laesies zoals carcinoom in situ. NBI is niet nuttig bij het voorspellen van invasieve tumoren of gradaties van tumoren. NBI-gerichte TURBT vermindert recidiefpercentages en recidiefvrije overleving. Maar de werkzaamheid ervan bij het vertragen van de progressie is niet bewezen.
Recent Advances in Bladder Cancer Diagnosis and Treatment
Klik op de titel van het abstract voor volledige dat hierboven is beschreven. Met meer dan 100 referenties:
Role of Macroscopic Image Enhancement in Diagnosis of Non-Muscle-Invasive Bladder Cancer: An Analytical Review
Prashant Motiram Mulawkar1,2*†, 
Gyanendra Sharma3†, 
Ashwin Tamhankar4†, 
Utsav Shah5† and 
Rickaz Raheem6- 1Department of Urology, Tirthankar Superspeciality Hospital, Akola, India
- 2Tutor in Urology, University of Edinburgh, Edinburgh, United Kingdom
- 3Chitale Clinics Private Ltd., Solapur, India
- 4Apollo Hospital, Navi Mumbai, India
- 5Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
- 6Milton Keynes University Hospital, Eaglestone, United Kingdom
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.
Conclusions
All these macroscopic image enhancement modalities have proven their utility in improved detection and short-term cancer control. Some studies have shown beneficial effects in terms of delayed progression and improved post cystectomy outcomes with PDD. NBI may be an acceptable alternative to PDD if some of the meta-analyses are to be believed. Most of the image enhancement modalities have not proven their utility in delaying progression or long-term cancer control. Most of these modalities claim to result in more complete TURBT. The presence of detrusor muscle is the surrogate marker for the completeness of TURBT. Data on the effect of an image enhancement modality on the presence of detrusor muscle in TURBT specimens are lacking. Cancer progression and long-term control are governed by the biological nature of cancer cells. PDD may have some role in early detection in this regard. However, 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.
Author Contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of Interest
GS was employed by Chitale Clinics Private Ltd.
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's Note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Keywords: bladder cancer, image enhancement, fluorescence cystoscopy, narrow band imaging, image 1 S
Citation: Mulawkar PM, Sharma G, Tamhankar A, Shah U and Raheem R (2022) Role of Macroscopic Image Enhancement in Diagnosis of Non-Muscle-Invasive Bladder Cancer: An Analytical Review. Front. Surg. 9:762027. doi: 10.3389/fsurg.2022.762027
Received: 20 August 2021; Accepted: 17 January 2022;
Published: 21 February 2022.
Edited by:
Jeremy Teoh, The Chinese University of Hong Kong, ChinaReviewed by:
Daniele Castellani, Polytechnic University of Le Marche, ItalyReza Sari Motlagh, Medical University of Vienna, Austria
Copyright © 2022 Mulawkar, Sharma, Tamhankar, Shah and Raheem. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Prashant Motiram Mulawkar, pmulawkar@hotmail.com
†ORCID: Prashant Motiram Mulawkar orcid.org/0000-0002-6761-4985
Gyanendra Sharma orcid.org/0000-0002-0843-8109
Ashwin Tamhankar orcid.org/0000-0003-4043-1975
Utsav Shah orcid.org/0000-0002-9851-6296
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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