Objectives
To evaluate the comparative ability of Storz Professional Image Enhancement System (SPIES), photodynamic diagnosis (PDD) and white light cystoscopy (WLC) to reduce missing diagnoses of bladder cancer (BCa) independently by surgeon’s experience, and to evaluate the inter-observer agreement for WL, SPIES and PDD cystoscopy respectively.
Materials and Methods
26 patients with history of high grade BCa or with positive cytology and negative imaging underwent WLC, SPIES and PDD consecutively. All the procedures were performed by a consultant urologist expert with all 3 techniques and recorded. Videotapes edited of the procedures were then shown in a casual sequence to an audience of 14 urologists and non-urologists with different degrees of experience in bladder endoscopy, ranging from last year medical students (N=2), residents at different years of training (N=8) up to consultants (N=4). During the projection of the videos each operator had to indicate on a bladder map where he/her would have done the biopsy. The ability of decreasing missing diagnoses was evaluated comparing operator’s answers with the pathologic response obtained with the procedure performed by the experienced physician. The inter observer agreement for each procedure was taken as secondary endpoint.
Results
184 times a biopsy proven BCa flat area (and/or small papillary lesion) was missed. It happened 82 times (44.6%) with WLC, 59 (32.1%) with SPIES and 43 (23.3%) with PDD (p=0.002), independently from degree of surgeon’s experience (p=0.9). The concordance rate regarding the site of biopsy was lower with WLC (67.3%), higher with SPIES and PDD (68.3% and 69.0%, respectively) (p<0.001). The inter-observer agreement rate was 77.9% for WLC, 74.5% for SPIES and 78.8% for PDD. It did not differ between procedures (p=0.7).
Conclusions
New technologies such as PDD and SPIES appear to reduce the risk of false negative cystoscopies independently from the degree of experience of the operator.
