Narrow Band Imaging Evaluation Research Articles

Evaluation of narrow-band imaging in the diagnosis of sinonasal inverted papilloma.

Narrow-band imaging (NBI) can be used to differentiate benign sinonasal lesions NBI can be used in the preoperative identification of sinonasal inverted papilloma Future studies can focus on NBI for recurrent inverted papilloma and surgical margin guidance.

Endoscopic submucosal dissection of rectal lesion recurrence at the anastomosis site: when the staples lead the way.

A 75-year-old man underwent an anterior rectum resection due to an early neoplastic rectal lesion. On surveillance endoscopy 4 years later, the surgical anastomosis was identified at 8 cm from the anal margin and was associated with a 35-mm lateral spreading tumor (LST), compatible with neoplastic recurrence. The LST reached the anastomosis as well as an adjacent pseudodiverticular recess ([Fig. 1]). White-light and narrow-band imaging evaluation looking for signs of invasive disease were unremarkable, so endoscopic submucosal dissection (ESD) was decided upon.

Evaluation of narrow band imaging for diagnosis of unilateral nasal lesions.

This study aimed to investigate the effect of narrow band imaging (NBI) examination on differentiating diagnosis between benign and malignant neoplasms involving nasal cavity. A retrospective study was conducted to analyse cases from January 2018 to December 2019 at a single centre. A total of 188 consecutive patients who were newly diagnosed with lesions in unilateral nasal cavity underwent complete examination with white light endoscopy (WLE) and NBI endoscopy. Biopsy specimens were harvested from the target lesions and sent to the pathologist for definite diagnosis. Participants with a history of congenital malformation, trauma and surgery in nasal cavity were excluded from the study. Endoscopic diagnosis was assessed using sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV, respectively). In identifying benign and malignant lesions of nasal cavity, NBI had a significant higher sensitivity (92.7% vs 70.7%, P=.020) and NPV (98% vs 92.3%, P=.032) than WLE, but there were no significant differences between NBI and WLE in specificity (98.6% vs 97.3%, P=.684), accuracy (97.3% vs 91.5%, P=.416) and PPV (95% vs 87.9%, P=.400). NBI as an emerging technique can improve the diagnostic accuracy by distinguishing benign and malignant lesions in nasal cavity and remains a promising and helpful adjunct to the endoscopy techniques.

Role of Narrow Band Imaging Endoscopy in Preoperative Evaluation of Laryngeal Leukoplakia: A Review of the Literature.

Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive cancer. Narrow band imaging (NBI) endoscopy has been introduced to improve early diagnosis of benign and malignant laryngeal lesions. The aim of this literature review was to evaluate the accuracy of preoperative evaluation of vocal fold leukoplakia with NBI endoscopy in comparison with histology. A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using 3 different databases: PubMed, Embase, and Scopus. The included articles in the systematic review were identified combining each of the following terms: "narrow band imaging" OR "NBI," [AND] with each of these terms: "laryngeal leukoplakia," OR "vocal fold leukoplakia," OR "vocal cord leukoplakia." The articles that fully met the inclusion criteria were 5 case series, conducted between January 2010 and February 2018, and published between 2017 and 2019. The selected articles included 312 patients (86% males and 14% females), affected by 382 vocal cord leukoplakia, evaluated with NBI endoscopy and that underwent surgical microlaryngoscopy with biopsy. Based on the studies included in the review, accuracy of NBI in predicting malignancy within leukoplakia ranged from 81% to 97.8%, demonstrating to be an accurate method to predict the risk of malignant transformation of vocal fold leukoplakia. Narrow band imaging can help otolaryngologists in the decision-making process on the necessity to perform a biopsy and transoral surgery or long-term follow-up. Larger studies are necessary to confirm the high association of NBI evaluation of the epithelium surrounding the leukoplakia with the histological diagnosis.

Evaluation of narrow band imaging in the assessment of laryngeal granuloma

Laryngeal granulomas belong to common complications following trans-oral laser microsurgery (TLM). The aim of this study was to evaluate NBI in the differentiation between granuloma-like lesions and local tumor recurrence. 154 consecutive patients after TLM due to early laryngeal cancer were enrolled. In the group, a monthly follow-up including NBI endoscopy was performed. Moderate and severe dysplasia, carcinoma in situ and invasive cancer were defined as positive histology, laryngeal granuloma and other benign laryngeal lesions as negative histology and premalignant lesions as suspicious histology. In 47/154 (31%) cases, granuloma-like lesion (GLL) was found. Patients with GLL were divided into two groups based on the NBI classification. In all patients, the microvascular pattern in NBI was compared with the final histology. In group A, with suspicious, perpendicular vessels, 13/13 (100%) samples were positive. In group B, with normal vascular pattern 3/34 (9%) samples were positive and 31/34 (91%) samples were negative. There was a significant correlation between the positive NBI vascular pattern and the final histology (p = 0.00001). Sensitivity, specificity, accuracy of NBI were as follows: 81%, 100%, 94%, respectively.Based on our results, NBI can reliably differentiate between postoperative laryngeal granuloma and local tumor recurrence. In such a manner, this method is very helpful in the follow-up of tumor patients.

Reliability and accuracy of blue light imaging for staging of intestinal metaplasia in the stomach

Background and aims: An endoscopic grading system (EGGIM) using narrow-band-imaging (NBI) has shown to accurately identify patients with extensive gastric intestinal metaplasia (GIM). However, description with alternative systems such as blue-light-imaging (BLI) is limited. The aim of this study is to determine the reliability and accuracy of BLI-bright regarding diagnosis and staging of GIM.Methods: Reliability of WLE (white-light-endoscopy) and BLI among 6 observers was assessed using a standard classification based on endoscopic images. Afterward, 37 patients were submitted to gastroscopy using FujifilmEG-760Z and endoscopists had to determine EGGIM score using BLI-bright and to perform gastric biopsies for operative-link-of-gastric-intestinal-metaplasia (OLGIM) calculation. BLI-bright accuracy was determined by comparing results with prior EGGIM scores with NBI and current OLGIM.Results: Compared with WLE, the interobserver reliability between observers was substantially better with BLI (Weighted Kappa: 0.8 vs 0.41). There was an 84% agreement between BLI and NBI assessing EGGIM intervals (EGGIM 0-4vs5-10). The area under the ROC curve was 0.90 (95%CI: 0.79–1.0) using the cut-off of EGGIM > 4 to determine advanced GIM, with a sensitivity of 100% (95%CI: 88–100%).Discussion: BLI-bright is reliable for the diagnosis of gastric intestinal metaplasia and agrees significantly with NBI evaluation. Preliminary data suggests high sensitivity for identifying patients with increased risk of gastric cancer.

Narrow-band imaging: a useful tool for early recognition of oral lichen planus malignant transformation?

Oral lichen planus (OLP) lesions have an overall malignant transformation rate of 1.37%. In patients with chronic disease, the diagnosis of malignancy relies on histopathological examination guided by clinical suspicion. Narrow-band imaging (NBI) is a promising endoscopic technique which, using a filtered light with specific wavelengths, can highlight microvascular abnormalities associated with subclinical neoplastic changes of the upper aerodigestive tract epithelium. This study aimed to analyse the value of NBI in selecting patients for biopsy before the emergence of clinical changes, allowing early detection of oral malignancies arising from OLP. A prospective study was conducted, enrolling 32 consecutive patients with a histological diagnosis of OLP with no previous diagnosis of oral cancer or other oral inflammatory diseases. Patients with suspicious NBI lesions underwent biopsies, while other patients were included in the follow-up. Two patients were judged positive at NBI evaluation and squamous cell carcinoma was diagnosed after histological examination. None of the other patients developed clinical features of malignancies during follow-up. NBI evaluation may increase the accuracy of detection of subclinical neoplastic transformation in OLP lesions and further encourage clinicians to perform biopsies in selected cases.

Intra and interobserver agreement of narrow band imaging for the detection of head and neck tumors.

Narrow band imaging (NBI) in combination with white light endoscopy (WLE) has improved the accuracy for the diagnosis and follow-up of head and neck carcinomas by identifying changes in the vascular patterns of the mucosa. However, NBI evaluation is explorer-dependent and may be influenced by the learning curve. The aim of this study is to assess the intra and interobserver agreement of NBI and WLE at the office, under local anaesthesia, by either experienced or non-experienced observers. Eighty-seven images of head and neck lesions were routinely collected under WLE and NBI. A group of three experienced otolaryngologists and three medical students assessed the images after a brief training. No additional patient information was provided. The same protocol was repeated after three weeks. Intra and interobserver agreement were calculated with the kappa index. NBI intraobserver agreement was substantial (κ = 0.62) and better than with WLE alone, which was moderate (κ = 0.57) in both groups. Interobserver agreement was moderate with WLE (κ = 0.58) and substantial with NBI (κ = 0.63). Both groups improved intraobserver and interobserver agreement with the implementation of NBI. Intra and interobserver agreement with NBI for the evaluation of head and neck lesions are substantial, and improve the results of WLE alone in both, professionals and trainees.

Evaluation of narrow band imaging for children with abdominal Henoch-Schonlein purpura

Objective To evaluate value of narrow band imaging(NBI) endoscopy for children with abdominal Henoch-Schonlein purpura(HSP). Methods A total of 46 patients with abdominal HSP were enrolled into the observation group(NBI intervention) from November 2010 to February 2016.Diagnostic rates of white light and NBI endoscopy in abdominal HSP patients, IgA positive rates of targeted biopsies and severe complications were retrospectively analyzed. A total of 25 abdominal HSP patients with no NBI intervention admitted from 2007 to 2009 were randomly enrolled into control group. Data of the control group were compared with those of observation group. Results In observation group, the diagnostic rate under NBI was significantly higher than that under white-light endoscopy[91.3%(42/46)VS 67.4%(31/46), χ2=8.02, P<0.05]. IgA positive rates of targeted biopsies under NBI was significantly higher than that under white-light endoscopy[95.7%(88/92)VS 69.6%(64/92), χ2=21.79, P<0.05]. Three patients developed such serious complications as digestive hemorrhage as predicted. Compared with control group, abdominal pain and blood stool relief time (10.96±5.32 d VS 19.68±4.29 d, t=7.50, P<0.01), fasting time(10.37±5.42 d VS 8.80±3.71 d, t=7.73, P<0.01), hospital stay (18.80±7.11 d VS 23.12±4.36 d, t=3.16, P<0.01), time of stool occult blood negative (11.41±6.30 d VS 19.12±4.09 d, t=6.22, P<0.01) in observation group were significantly shortened. Conclusion NBI endoscopy is valuable for improving the diagnostic accuracy and biopsy accuracy and complication prediction of abdominal Henoch-Schonlein purpura in children. Key words: Child; Henoch-Schonlein purpura; Endoscopy; Therapeutic endoscopy; Narrow band imaging

Narrow band imaging as screening test for early detection of laryngeal cancer: a prospective study.

To analyse the specificity and sensibility of narrow band imaging illumination technology in the early detection of laryngeal cancer in the patients' population without previous diagnosis of laryngeal cancer in a screening setting. Unicentre, prospective study. One tertiary medical centre. A total of 158 patients completed all protocol steps. Sensitivity, specificity, positive and negative predictive values of narrow band imaging (NBI) in detecting precancerous lesions and early laryngeal cancer. The blind assessment of NBI patterns concurred in 90% of patients. In identifying laryngeal cancer and its precursor lesions, in-office NBI showed a high sensitivity of 97% (CI, 84.2%-99.9%), specificity of 92.5% (CI, 79.6%-98.4%), PPV of 91.4% (CI, 76.9%-98.2%), NPV of 97.4% (CI, 86.2%-99.9%) and accuracy of 94.5% but intra-operative NBI demonstrated a sensitivity of 97% (CI, 84.2%-99.9%), a slightly higher specificity of 95% (CI, 83.1%-99.4%), PPV of 94.1% (CI, 80.3%-993%), NPV of 97.4% (CI, 86.5%-99.9%) and accuracy of 95.9%. The comparative receiver operating characteristic curves confirmed a slightly higher performance for the intra-operative NBI evaluation without any statistical significance (P = 0.41). Our results confirm the high values of sensitivity and specificity of NBI system in detecting pre-neoplastic laryngeal lesions or early laryngeal cancer in a patients' population selected only by means of risk factors exposure and confirmed the potential role of NBI evaluation as in-office screening tool.

Narrow Band Imaging as an Efficient and Economical Tool in Diagnosing Colorectal Polyps.

Narrow Band Imaging as an Efficient and Economical Tool in Diagnosing Colorectal Polyps.

A prospective randomized comparative study of cold forceps polypectomy by using narrow-band imaging endoscopy versus cold snare polypectomy in patients with diminutive colorectal polyps

A previous study reported that cold snare polypectomy (CSP) was superior to cold forceps polypectomy (CFP) for the removal of diminutive colorectal polyps (DCPs) (≤5 mm) when the techniques were assessed for completeness of resection. However, completeness is expected to be greater with CFP when strict investigation of the remnant polyp is performed. The aim of this study was to assess the efficacy of CFP with narrow-band imaging (NBI) evaluation of polypectomy sites for removal of DCPs, compared with CSP. This was a randomized, controlled, noninferiority trial at a tertiary-care referral hospital. Of the 380 patients screened, 146 patients with 231 DCPs were enrolled. CFP was used to resect DCPs until no remnant polyp was visible by NBI endoscopy. The primary noninferiority endpoint was histologic eradication of polyps, with a noninferiority margin of -10%. A size of >3 mm was seen in 129 polyps (55.8%). The overall rates of histologic eradication were 90.5% in the CFP group and 93.0% in the CSP group (difference, 2.5%; 95% confidence interval [CI], -9.67 to 4.62). However, when confined to the polyps >3 mm, the histologic eradication rate was 86.8% and 93.4% (95% CI, -17.2 to 3.6), respectively. Polyp size, histology, location, and time taken for polypectomy did not differ between the groups. The failure rate of tissue retrieval was higher in the CSP than in the CFP group (7.8% vs 0.0%, respectively; P =.001). In this study, >90% of all DCPs were completely resected by using CFP with NBI evaluation of polypectomy sites, showing noninferiority compared with CSP. However, in polyps measuring >3 mm, CFP failed to show noninferiority versus CSP. CFP appears to be the proper method for resection of DCPs 1 to 3 mm in size if no remnant polyp is visible by NBI endoscopy, but CFP is likely to be insufficient for larger polyps. ( NCT02201147.).

Narrow-band imaging in the prediction of surveillance intervals after polypectomy in community practice.

It has been proposed that the use of narrow-band imaging (NBI) for real-time histological assessment to determine postpolypectomy surveillance intervals is a cost-effective approach to the management of diminutive polyps. However, significant discrepancies in NBI performance have been observed among endoscopists; hence, professional societies recommend training, monitoring, and auditing. The aim of the present study was to evaluate the performance of real-time optical diagnosis for diminutive polyps after the inclusion of this approach in an internal quality assurance program, in order to assess its applicability in clinical practice Patients and methods: Four endoscopists attended periodic training sessions on NBI assessment of polyp histology before and during the study. Performance was audited and periodic feedback was provided. The accuracy of high-confidence NBI evaluation for polyps ≤ 5 mm in predicting surveillance intervals according to the European and US guidelines, and the negative predictive value (NPV) for adenoma in the rectosigmoid were calculated and compared with recommended thresholds (90 % agreement and 90 % NPV, respectively). Overall, 284 outpatients (mean age 61.3 ± 18.2 years; 63 % males) were enrolled. A total of 656 polyps were detected, 465 of which (70.9 %) were diminutive (70.5 % adenomas). Sensitivity, specificity, positive and negative predictive values, and accuracy of high-confidence NBI predictions for adenoma in diminutive lesions were 95.3 %, 83.5 %, 93.5 %, 87.6 %, and 91.9 %, respectively. High-confidence characterization of diminutive polyps predicted the correct surveillance interval in 95.8 % and 93.3 % of cases according to European and American guidelines, respectively. NPV for adenoma in the rectosigmoid was 91.3 % For community settings in which endoscopists are adequately trained and performance is periodically audited, real-time optical diagnosis for diminutive polyps is sufficiently accurate to avoid postpolypectomy histological examination of resected lesions, or to leave rectosigmoid hyperplastic polyps in place. Trial registered at ClinicalTrials.gov (NCT02196402).

Sa1577 A Prospective Dual Centre Evaluation of Narrow Band Imaging (NBI) With a Fixed Zoom Function in Real Time Prediction of Polyp Histology. Can WE Resect and Discard?

Sa1577 A Prospective Dual Centre Evaluation of Narrow Band Imaging (NBI) With a Fixed Zoom Function in Real Time Prediction of Polyp Histology. Can WE Resect and Discard?

Intraoperative narrow band imaging better delineates superficial resection margins during transoral laser microsurgery for early glottic cancer.

The high rate of positive margins after transoral laser microsurgery (TLM) remains a matter of debate. This study investigates the effect of intraoperative narrow band imaging (NBI) examination on the incidence of positive superficial surgical margins in early glottic cancer treated by TLM. Between January 2012 and October 2013, 82 patients affected by Tis-T1a glottic cancer were treated with TLM by type I or II cordectomies. Intraoperative NBI evaluation was performed using 0-degree and 70-degree rigid telescopes. Surgical specimens were oriented by marking the superior edge with black ink and sent to a dedicated pathologist. Comparison between the rate of positive superficial margins in the present cohort and in a matched historical control group treated in the same way without intraoperative NBI was calculated by chi-square test. At histopathological examination, all surgical margins were negative in 70 patients, whereas 7 had positive deep margins, 2 close, and 3 positive superficial margins. The rate of positive superficial margins was thus 3.6% in the present group and 23.7% in the control cohort (P<.001). Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation during TLM for early glottic cancer.

Visual evaluation of the larynx and hypopharynx during esophagogastroduodenoscopy: a safety and feasibility study.

The larynx and hypopharynx are common sites for head and neck cancer, which shares many risk factors with upper digestive tract disease. Patient survival with malignancies depends on stage at the time of diagnosis. Endoscopic screening of the hypopharynx is neither routinely performed in clinical practice nor has it been evaluated in a formal study. This is a prospective pilot study of patients undergoing routine EGD. Demographic data were collected from patients prior to the procedure. All patients in the study underwent an EGD and prior to performing the standard portion of the EGD procedure, the endoscopist evaluated the larynx and hypopharynx with both white light endoscopy (WLE) and narrow band imaging (NBI). Details of the procedure, including ability to see all anatomic structures, time spent, complications, and findings, were recorded. A total of 111 patients were included in the study. The exam of the laryngopharynx was completed in 87% of patients (97/111). Reasons for incomplete exam included intubated patients (2/14), inadequate sedation (9/14), and inability to see the entire hypopharynx (3/14). The mean time of the WLE was 20.2 s, while the NBI evaluation took 15.6 s for a mean and 35.8 s for the entire exam of the larynx and hypopharynx. Minor procedural complications occurred in 3/11 (2.7%) of the patients and included hypotension, tachycardia, and hypoxia. There were 6 patients who had hypopharyngeal abnormalities seen on both WLE and NBI (5.4%) and were subsequently referred to otolaryngology. Of the six referrals, one patient had a vocal cord biopsy showing leukoplakia, while the others were deemed normal anatomic variants. Evaluation of the hypopharynx can be accomplished by gastrointestinal endoscopists at the time of EGD in the vast majority of patients in a safe manner while adding only about 35 s to the overall exam time.

Evaluation of narrow‐band imaging in the diagnosis of colorectal lesions: Is a learning curve involved?

The usefulness of endoscopy narrow-band imaging (NBI) in differentiating colorectal lesions has been demonstrated. However, the learning curve associated with this technique is a concern for endoscopists. Prior to carrying out these colonoscopies, four endoscopists attended a training course designed to teach the principles of NBI and application of the Sano Capillary Pattern (CP) classification criteria. Following a pre-test, endoscopists used NBI with magnification and CP analysis for real-time colonoscopy exams to predict lesion histology. Three sets of 15 lesions were imaged. These three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. non-target lesions). The diagnostic accuracy of each endoscopist for each set of lesions was evaluated to assess the learning curve associated with the application of NBI. Overall accuracy, sensitivity, and specificity for differentiating neoplastic and non-neoplastic lesions were 95.4%, 98.0%, and 92.0%, respectively. For target lesions versus non-target lesions, the diagnostic accuracy associated with the second set of lesions was better than that achieved with the first set of lesions (78.3% vs 96.7% (P = 0.02) and 70.0% vs 96.7% ( P < 0.01), respectively in each case). In contrast, the difference in diagnostic accuracy between the second and third sets of lesions was not significant. NBI with magnification is a useful tool for the diagnosis of colorectal lesions. Moreover, following a short training program and with minimal clinic practice, less experienced endoscopists were able to become competent in the method.

Tu1658 The Diagnosis of Colorectal Cancer With NBI Magnifying Endoscopy, Magnifying Chromoendoscopy and Endocytoscopy

The Diagnosis of Colorectal Cancer With NBI Magnifying Endoscopy, Magnifying Chromoendoscopy and Endocytoscopy Shin-Ei Kudo, Yoshiki Wada, Tomoyuki Ishigaki, Masashi Misawa, Yuichi Mori, Kunihiko Wakamura, Hideyuki Miyachi, Nobunao Ikehara, Fuyuhiko Yamamura, Shigeharu Hamatani Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; Department of Pathology, Showa University Northern Yokohama Hospital, Yokohama, Japan Aim: The aim of this prospective study is to compare the usefulness of magnifying narrow band imaging (NBI), magnifying chromoendoscopy and endocytoscopy for the diagnosis of colorectal lesions and providing precise treatment decision by means of a thorough NBI evaluation combined to pit pattern. Method: The subject sample was composed of 278 patients who underwent a complete colonoscopic examination and endoscopic or surgical treatment from January 2006 to June 2010. A total of 290 submucosal invasive cancerous lesions was evaluated. The NBI/chromoendoscopy digital images were recorded and the diagnosis was made independently from each other by two endoscopists who were blinded to the final pathological conclusion. The vascular pattern was classified into six classes accordingly to our service1. The pit pattern was classified according to Kudo’s classification. The findings of endocytoscopy were classified into five classes2. In submucosal cancers, 145 cases were treated surgically. What so ever Kudo’s classification was used for the degree of submucosal invasion and classified cancer accordingly. Prediction of the invasion depth is very important for deciding a way of intervention. Sm1a or 1b cancer without vessel permeation does not metastasize. In contrast, sm1c, sm2 or sm3 lesions show a substantial proportion (around 10%) of nodal metastasis. Massively invasive submucosal cancer (SMm) was indicated for surgical operation. Slightly invasive submucosal cancer (SMs) was indicated for endoscopic treatment. Results: By recognizing irregular or sparse vascular pattern with NBI, SMm could be diagnosed with sensitivity and specificity of 94.9% and 76.0% respectively. Through chromoendoscopy, the differentiation between SMm and SMs was achieved by evaluating the pit pattern with sensitivity of 89.7% and specificity of 88.0%. On the other hand, when assuming EC3b endocytoscopical class as SMm, SMm could be diagnosed with sensitivity and specificity of 89.9% and 90.0% respectively. Conclusion: In diagnosis of submucosal cancer, the specificity of pit pattern was superior to NBI colonoscopy. Thus, it is desirable to perform chromoendoscopy in addition to NBI for distinguishing between SMs and SMm lesions and determining treatment selection, whether endoscopical or surgically. Nevertheless, since a high accurate method, endocytoscopy might prove the best treatment selection in the future.1. Wada Y, Kudo S, Kashida H et al. The diagnosis of colorectal lesions with magnifying narrow-band imaging system. Gastrointest Endosc 2009; 70: 522-312. Kudo S, Takemura O, Ohtsuka K. Flat and Depressed Types of Early Colorectal Cancers: From East to West. Gastrointest Endoscopy Clin N Am 2008; 18: 581-593.

Mo1522 The Diagnosis of Colorectal Cancer With NBI Magnifying Endoscopy, Magnifying Chromoendoscopy and Endocytoscopy

Mo1522 The Diagnosis of Colorectal Cancer With NBI Magnifying Endoscopy, Magnifying Chromoendoscopy and Endocytoscopy

Evaluation of Narrow-Band Imaging as a Complementary Method for the Detection of Bladder Cancer

We evaluated the use of narrow-band imaging (NBI) cystoscopy for the detection of bladder cancer and analyzed its diagnostic efficacy in cases of carcinoma in situ (CIS) and in cases with known urine cytology results. A prospective controlled study of NBI was conducted in 104 consecutive patients with definite or suspected bladder cancer. Transurethral targeted biopsies were performed after white light imaging (WLI) and NBI cystoscopy, and the histologic outcomes were compared. A total of 313 biopsies were taken, including 161 from sites identified as potentially abnormal by NBI and/or WLI cystoscopy, and 152 from apparently normal sites. The percentage of malignancies in the sites identified only by NBI was 55.7% (39/70 places). In 26.9% of patients (28/104), bladder tumors were detected only by NBI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of a negative test (NLR) for the detection of bladder tumors using NBI in all patients were 92.7%, 70.9%, 63.4%, 94.7%, and 0.10, respectively. The sensitivity, specificity, PPV, NPV, and NLR for the detection of CIS using NBI were 89.7%, 74.5%, 78.8%, 87.2%, and 0.14, respectively. The sensitivity, specificity, PPV, NPV, and NLR for the detection of bladder tumors using NBI in patients with positive vs negative urine cytology were 85.4% vs 98.4%, 75.7% vs 66.3%, 61.2% vs 64.5%, 92.0% vs 98.5%, and 0.19 vs 0.02, respectively. NBI is a simple and effective method for identifying bladder tumors including CIS without the need for dyes because of its high sensitivity, high NPV, and low NLR.