<p><strong> </strong><strong>In patients with NMIBC, clinicians may use NBI to increase detection and decrease recurrence. (<em>Conditional Recommendation; Evidence </em></strong><strong><em>Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>One trial evaluating outcomes following use of NBI versus WLC found that NBI was associated with a lower risk of bladder cancer recurrence at 3 months (3.9% versus 17%; odds ratio [OR]: 0.62; 95% CI: 0.41 to 0.92) and at 12 months (OR: 0.24; 95% CI: 0.07 to 0.81).<sup>313</sup><sup> </sup>Another trial (n=179) found NBI plus WLC to be associated with a non-statistically significant decreased risk of recurrence at 1 year versus WLC in patients with multiple tumors >3 cm in diameter (7.9% versus 18%; RR: 0.44; 95% CI: 0.19 to 1.02).<sup>314</sup><sup> </sup>Another randomized trial of 600 patients undergoing either white light/white light or white light/NBI cystoscopy for previously diagnosed high-risk NMIBC showed no benefit with regards to recurrence for patients undergoing second look with NBI (26% (78/300) versus 23% (70/300); p=0.507) There was also no difference in time to recurrence between groups.<sup>315</sup> Four recent systematic reviews have examined WLC versus white light plus NBI.<sup>308, 316-318</sup> In a combined analysis of six RCT’s, one systematic review found improved recurrence for NBI plus white light versus white light alone in patients with suspected or confirmed NMIBC (HR: 0.63; 95% CI: 0.45 to 0.89; I<sup>2</sup>=53%; 6 RCTs; 1,244 patients).<sup>317</sup> The other three systematic reviews found no difference in recurrence with white light versus white light plus NBI cystoscopy<sup>308, 309, 319</sup></p>
<p>The Panel acknowledges that NBI technology is readily available to many clinicians. While not proven to decrease recurrence, there is no evidence of additional risk incurred by patients with its use.</p>