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This single-surgeon, randomized, controlled trial examined patients who underwent narrow-band imaging (NBI) versus white-light imaging (WLI) during transurethral resection (TUR) for bladder tumours. Patients with high-risk (high-grade pTa, pT1, carcinoma in situ [CIS]) bladder neoplasms were evaluated. All patients underwent restaging TUR after first WLI-TUR and were randomized 1:1 by random permuted blocks to undergo either WLI-assisted or NBI-assisted second TUR. Patients underwent an induction course of bacillus Calmette-Guérin (BCG) therapy and received no maintenance therapy. Of the 254 patients, 127 underwent NBI-TUR and 127 had WLI-TUR; 22% of the patients in the NBI-TUR group recurred compared with 33% after WLI-TUR (p=0.05). The mean recurrence-free survival (RFS) time was significantly greater for the NBI-TUR group at 22 months versus 19 months for the WLI-TUR group (p=0.02). As mentioned by the author, limitations include the study being underpowered and observer bias due to NBI-TUR being performed after both WLI and NBI cystoscopy were used to inspect the bladder.
While the study is thought provoking, a multiinstitutional randomized study needs to be conducted in a larger number of patients prior to concluding definitive superiority as well as cost effectiveness of NBI-TUR for bladder tumours. Moreover, utilization of induction followed by maintenance BCG therapy in such a trial would be of interest.