Emerging Endoscopic and Photodynamic Techniques for Bladder Cancer Detection and Surveillance

Table 1

Overview of NBI and PDD techniques.

	NBI	PDD
Optical principle	Absorption	Fluorescence
Costs stack	Equivalent	Equivalent
Costs scopes	Can be used on compatible “scopes”	New rigid “scopes” with blue light filter are required
Costs staff	Nil	Extra
Costs consumables	Nil	Extra
Convenience	Very convenient	Inconvenient
Extra invasiveness for patient	None	Extra catheterisation for preoperative instillation of photosensitising agent
Sensitivity (%) for visualisation of bladder tumours	93–100	82–97
Specificity (%) for visualisation of bladder tumours	68–82	41.4–98.5
On Initial suspicion of bladder cancer diagnosis	Good in an outpatient setting at initial cystoscopy	Good in an inpatient setting at time of TURBT
On CIS diagnosis	Accuracy of 83% [38]	Good
In patients with positive urine cytology but negative WLC	Not known	Recommended
For assessment at time of tumour recurrences in patients not previously staged with NBI/PDD	Not known	Recommended
Tumour treatment	Good in outpatient setting for ablation of tumours by diathermy or laser, especially for recurrences during surveillance	Good in an inpatient setting in conjunction with TURBT
Haematuria clinic	Considerable potential	Impractical due to patient numbers and not all patients presenting to haematuria clinic have UC
For surveillance	Good. Effect of previous BCG, inflammation or scarring is yet unknown	No data available. Specificity is reduced in patients who have had previous BCG, inflammation, or scars and hence limits the use
Extra applications	Upper urinary tract, upper and lower GI, and so forth	Nil
As a teaching tool	Good	Good