Diagnostische und therapeutische Aspekte des Narrow Band Imaging beim Harnblasenkarzinom
Diagnostic and therapeutic aspects of Narrow Band Imaging in bladder cancer
von Christoph Zerrenner
Datum der mündl. Prüfung:2020-02-06
Betreuer:Prof. Dr. Hans W. Wechsel
Gutachter:Prof. Dr. Jochen Gaedcke
Gutachter:Prof. Dr. Thomas Meyer
EnglischBACKGROUND: Narrow Band Imaging (NBI) is an easy endoscopic procedure introduced to be beneficial to common white light cystoscopy by using specific bands (hemoglobin absorption maxima) of white light and therefore showing higher contrasts of vessels and maybe support diagnostic value considering tumor invasion and periphery. In this dissertation, the predictive value of vascular morphology of bladder carcinoma in the imaging technique narrow band imaging was examined with regard to the prediction of tumor expansion, depth of infiltration and tumor margin extension. New studies show higher sensitivity and a good negative predictive value by low costs and the possibility to improve outpatient care. METHODS: We examined patients from May 2014 to December 2016. In a preliminary investigation of a convenience sample, we gathered experience with the NBI technology. We compared intraoperative findings with the final histology regarding tumor stage, depth of invasion, tumor borders and the optical aspect of the tumor. In a subsequent investigation of 26 tumors in 24 patients (13 male and 11 female, mean age 71.5 years), the tumor stage and tumor boundaries were predicted before the histology was obtained. In addition, the tumor detection rates in NBI, PDD and white light cystoscopy were compared. RESULTS: The NBI technique was not inferior to the other imaging techniques in terms of tumor detection. A stage forecast was successful, but not with sufficient certainty. The tumor boundaries (71.4% correct) and the depth of invasion were assessed with moderate certainty. A scheme to differentiate the tumor stages could be developed. CONCLUSION: In NBI it was possible to reliably differentiate between urocystitis and bladder carcinoma. A clear prediction of the tumor stage does not seem possible and remains the domain of the histological examination. However, with increasing expertise, a distinction can largely be made between low grade and high grade tumors. The tumor detection and determination of the tumor boundary is successful in NBI. Overall, however, the combination of all imaging techniques seems to make the most sense. Further studies are needed to know how cystoscopic findings can be improved.