Narrow BaNd ImagINg IN UrologyReview of clinical evidence in NMIBC.

2 3

HIgH defINItIoN Narrow BaNd ImagINg – tecHNIcal PrINcIPle

HD-NBI filters the white light and improves the visual contrast of mucosal and vessel structures.

Excellent view of mucosal and vessel structures even with HDTV white light.

Submucosal veins

Capillary on the mucosal

surface

The challenge in NMIBC management:

reviewing the literature, 50–70% of NmIBc patients suffer from recurrences after the initial treatment in form of

superficial tumours1. missing small papillary tumours or cIS is an acknowledged risk, at an estimated rate of

10–20%2. Superficial tumours of the mucosa are typically indicated by specific capillary and vessel structures.

Identifying these structures – especially small tumours under white light conditions – is possible, but could be

improved.

This is where HD-NBI helps.

∙ Hd-NBI enhances the contrast of vessels and papillary structures to help identify tumours

∙ Hd-NBI enhances the fact that haemoglobin has an increased absorption rate for light at wavelengths of blue

and green colour

∙ Hd-NBI light is generated by a patented filter, eliminating all other disturbing wavelengths with the exception of

blue and green

Where HD-NBI is available:

∙ rigid and flexible cystoscopy

∙ tUr-B resection

∙ flexible ureteroscopy for upper tract tumour management

Narrow Band Imaging – clinical advantages:

∙ Hd-NBI provides increased accuracy to not miss lesions

∙ Significantly higher tumour detection rate for Narrow Band Imaging versus conventional cystoscopy

(94.7% versus 79.2%1 and 94.8% versus 83.9%2)

∙ Substantially more tumours found (35.9–38%1)

∙ NBI reduces the recurrence risk of NmIBc by at least 10% at one year3

Narrow Band Imaging – practical advantages:

∙ No contraindications

∙ No installations or disposables needed – available at the push of a button

∙ available at no extra cost

∙ Integrated in olympus imaging tower

Deg

ree

of

ligh

t ab

sorp

tio

n

300 400 500 600 700 800wavelength (nm)

415 nm light 540 nm light

The light absorption characteristic of haemoglobin as a function of wavelength

1 Sylvester et al., Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials, J Urol 2002; 168:1964–1970

2 Jichlinski et al., Fluorescence cystoscopy in the management of bladder cancer: a help for the urologist!, Urol. Int. 2005; 74: 97–101

1 Cauberg et al., Narrow band imaging cystoscopy improves the detection of nonmuscle-invasive bladder cancer, Urology 2010; 76:658–6632 Geavlete et al., Narrow-band imaging cystoscopy in non-muscle-invasive bladder cancer: a prospective comparison to the standard approach, Therapeutic Advances in Urology 2012;

4(5):211–217

3 Puppo et al., A Randomized Prospective Trial to Assess the Impact of Transurethral Resection in Narrow Band Imaging Modality on Non–Muscle-Invasive Bladder Cancer Recurrence,

European Urology 2012; 61:908–913

4 5

revIew of clINIcal data oN NBI IN Bladder caNcer maNagemeNt

Measurements: the 1-yr recurrence risks in NBI or

wl tUr groups were compared using odds ratio (or)

point and interval estimates derived from logistic

regression modeling.

Results and limitations: the 1-yr recurrence-risk

was 25 of 76 patients (32.9%) in the NBI and 37 of 72

patients (51.4%) in the wl group (or = 0.62; p =

0.0141). Simple and multiple logistic regression analyses

provided similar or points and interval estimates.

Conclusions: tUr performed in the NBI modality

reduces the recurrence risk of NmIBc by at least

10% at 1 yr.

© 2012 European Association of Urology. Published by

Elsevier B.V. All rights reserved.

a Department of Urology, IRCCS Azienda Ospedaliera Universitaria

San Martino – IST Istituto Nazionale per la Ricerca sul Cancro,

Genoa, Italy;

b Department of Anatomy and Histopathology, IRCCS Azienda

Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la

Ricerca sul Cancro, Genoa, Italy;

c Department of Epidemiology, Biostatistics and Clinical Trials, IRCCS

Azienda Ospedaliera Universitaria San Martino – IST Istituto

Nazionale per la Ricerca sul Cancro, Genoa, Italy;

d Department of Urology, San Remo Hospital, Imperia, Italy

* Corresponding author. Urology, IRCCS Azienda Ospedaliera

Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul

Cancro, Largo Rosanna Benzi 10, Genoa 16132, Italy.

Tel. +39 0105600548; Fax: +39 0105600283. E-mail addresses:

angelo.naselli@libero.it, angelo.naselli@auro.it (A. Naselli).

1 A Randomized Prospective Trial to Assess the

Impact of Transurethral Resection in Narrow

Band Imaging Modality on Non–Muscle-Invasive

Bladder Cancer Recurrence

angelo Naselli a,*, carlo Introini a, luca timossi a,

Bruno Spina b, vincenzo fontana c, riccardo Pezzi c,

francesco germinale d, franco Bertolotto d, Paolo

Puppo a,d

Background: Narrow band imaging (NBI) is an

optical enhancement technology that filters white light

into two bandwidths of illumination centered on 415

nm (blue) and 540 nm (green). NBI cystoscopy can

increase bladder cancer (Bca) visualization and

detection at the time of transurethral resection (tUr).

NBI may therefore reduce subsequent relapse

following tUr.

Objective: assess the impact of NBI modality on 1-yr

non–muscle-invasive Bca (NmIBc) recurrence risk.

Design, setting, and participants: consecutive

patients with overt or suspected Bca were included

in a prospective study powered to test a 10%

difference in 1-yr recurrence risk in favor of cases

submitted to NBI tUr. excluding patients with

muscle-invasive Bca, negative pathologic

examination, or without follow-up, the study

population was composed of 148 subjects

randomized from august 2009 to September 2010 to

NBI tUr (76 cases) or white light (wl) tUr (72

cases).

Intervention: tUr was performed in NBI or standard

wl modality.

· Overall, the BCa detection rate was 1.36 lesions per person in the WL group and 1.55 per

person in the NBI group ( p = 0.07)

· The 1-yr recurrence-risk was 25 of 76 patients (32.9%) in the NBI and 37 of 72 patients

(51.4%) in the WL group (OR = 0.62; p = 0.0141)

· TUR performed in the NBI modality reduces the recurrence risk of NMIBC by at least 10%

at one year

Puppo et al., A Randomized Prospective Trial to Assess the Impact of Transurethral Resection in Narrow

Band Imaging Modality on Non–Muscle-Invasive Bladder Cancer Recurrence, European Urology 2012;

61:908–913

6 7

revIew of clINIcal data oN NBI IN Bladder caNcer maNagemeNt

2 Diagnosis of narrow-band imaging in

non-muscle-invasive bladder cancer: A

systematic review and meta-analysis

Kaiwen li,1,2* tianxin lin,1,2* Xinxiang fan,1,2* yu duan3

and Jian Huang1,2

Objective:

the objective was to evaluate the diagnostic accuracy

of cystoscopy assisted by narrow-band imaging

compared with white-light imaging for non-

muscleinvasive bladder cancer.

Methods:

an electronic database search of Pubmed, embase, the

cochrane library, ovid and web of Science was carried

out for all articles comparing narrow-band imaging

with white-light imaging cystoscopy in the detection of

non-muscle-invasive bladder cancer. the review

process followed the guidelines of the cochrane

collaboration.

Results:

Seven studies with prospectively collected data

including a total of 1040 patients were identified,

and 611 patients with 1476 tumours were detected

by biopsy.

In the patient- and tumour-level analysis, an additional 17%

of patients (95% confidence interval, 10–25%) and an

additional 24% of tumours (95% confidence interval,

17–31%) were detected by narrow-band imaging,

respectively. In the patient- and tumour-level analysis,

significantly higher detection rates using narrow-band

imaging (rate difference 11%; 95% confidence interval

5–17%; P < 0.001; and rate difference 19%; 95%

confidence interval 12–26%; P < 0.001, respectively)

rather than white-light imaging were found. on the tumour

level, an additional 28% of carcinoma in situ was detected

(95% confidence interval 14–45%) by narrow-band

imaging, and a significantly higher detection rate (rate

difference 11%; 95% confidence interval 1–21%; P = 0.03)

was found. the false-positive detection rate of tumour level

did not differ significantly between the two techniques.

Conclusions:

cystoscopy assisted by narrow-band imaging

detects more patients and tumours of non-muscle-

invasive bladder cancer than white-light imaging, and

it might be an additional or alternative diagnostic

technique for non-muscle-invasive bladder cancer.

Key words:

cystoscopy, diagnostic imaging, meta-analysis,

review, urinary bladder neoplasms.

© 2012 The Japanese Urological Association

Published by International Journal of Urology (2013)

20, 602–609

1 Department of Urology, Sun Yat-sen Memorial Hospital,

2 Key Laboratory of Malignant Tumour Gene Regulation and Target

Therapy of Guangdong Higher Education Institutes, and

3 Clinical Medicine of Eight-Year Program, Zhongshan Medical

School, Sun Yat-sen University, Guangzhou, China

Correspondence: Jian Huang M.D., Ph.D., Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 W Yanjiang Road, Guangzhou 510120, China. Email: yehjn@yahoo.com.cn

*These authors contributed equally to this work. Received 19 May 2012;

accepted 25 September 2012. Online publication 1 November 2012

· First systematic review and meta-analysis of studies with a within-patient comparison of

NBI and WLI for NMIBC with 1040 patients

· Higher detection rates of NMIBC could result in more prompt treatment with a decreased

number of residual and recurrent tumours

· Impressive number of patients and tumours incl. CIS missed by WLI can be detected:

additional 17% of patients and additional 24% of tumours detected by NBI

Kaiwen et al., Diagnosis of narrow-band imaging in non-muscle-invasive bladder cancer: A systematic

review and meta-analysis, International Journal of Urology 2013; 20:602–609

Narrow Band Imaging – available for all

endo-urological procedures

∙ for outpatient bladder cancer follow-up by flexible

cystoscopy in combination with the compact

integrated video platform cv-170

∙ for upper tract tumour management with flexible

chip-on-the-tip ureteroscopy

∙ for bladder cancer resections in the operating theatre

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Narrow BaNd ImagINg IN Urology

Specifications, design and accessories are subject to change without any notice or obligation on the part of the manufacturer.

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