Diagnostic performance of narrow-band imaging and photodynamic diagnosis compared to white light cystoscopy for non-muscle invasive bladder cancer: A network meta-analysis of randomized trials

Abstract

Purpose: To compare the diagnostic performance of white light cystoscopy (WLC), photodynamic diagnosis (PDD), and narrow-band imaging (NBI) in the detection of non-muscle invasive bladder cancer (NMIBC) through a network meta-analysis of randomized controlled trials (RCTs). Materials and Methods: A systematic literature search of PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Web of Science was conducted in February 2024. RCTs comparing WLC, NBI, and PDD in patients with NMIBC were included. Six RCTs comprising 2,439 patients were analyzed. Diagnostic outcomes evaluated included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false-positive rate, and carcinoma in situ (CIS) sensitivity. A random-effects network meta-analysis was performed using Stata software. Risk of bias was assessed using the RoB 2 tool. Results: Both NBI and PDD demonstrated significantly improved sensitivity compared to WLC (odds ratio [OR] for NBI 7.66, 95% confidence interval [CI] 2.91-20.19; OR for PDD 7.85, 95% CI 3.76-16.38). PDD showed the highest CIS sensitivity (OR 13.37, 95% CI 4.38-40.89). WLC had the highest specificity (OR for PDD 0.29, 95% CI 0.08-1.00). NBI achieved the highest NPV (OR 8.28, 95% CI 1.34-51.28), while PDD showed the lowest PPV (OR 0.16, 95% CI 0.09-0.29). SUCRA (surface under the cumulative ranking curve) rankings supported these findings. Conclusions: NBI and PDD improve NMIBC detection sensitivity over WLC, notably PDD for CIS, despite lower specificity. WLC remains the most specific, and NBI offers a favorable balance between sensitivity and diagnostic precision.