Enhanced endoscopy with IMAGE1 S CHROMA improves detection of non-muscle invasive bladder cancer during transurethral resection.

Purpose - We assessed the ability of enhanced cystoscopy with CHROMA image enhancement (Karl Storz SE & Co. KG, Tuttlingen, Germany) to improve cancer detection during transurethral resection of bladder tumors (TURBT) in patients with known or suspected non-muscle invasive bladder cancer (NMIBC). Patients and Methods - A total of 49 patients (82% male) with a median age of 71 years underwent TURBT for known or suspected NMIBC. Bladders were assessed first with conventional white light imaging and then with CHROMA enhancement. We quantified the number of tumors seen with white light and any additional tumors seen with CHROMA and correlated with pathologic results. Results - A total of 165 tumors were visualized in 47 patients; of these, 25 were only seen using CHROMA. Use of CHROMA yielded additional tumors not appreciated on white light in 14 out of 39 patients with underlying malignancy, for an additional detection rate (ADR) of 36% (95% CI, 21-53%). CHROMA improved detection of tumors in the setting of both low-grade and high-grade disease with equal efficacy (ADR 43% in low grade and 44% in high grade, p = 0.98, Barnard exact test). Conclusions - Cystoscopy with CHROMA contrast enhancement facilitates detection of bladder tumors that are not readily appreciated using conventional white light cystoscopy. The technology integrates seamlessly with current practice and can serve as an adjunct to other novel technologies.