Narrow Band Imaging Cystoscopy Research Articles

Photodynamic cystoscopy for bladder cancer diagnosis and for NMIBC follow-up: An overview of systematic reviews and meta-analyses

Currently, bladder cancer detection is based on cytology and cystoscopy. White light cystoscopy (WLC) is an invasive procedure and may under-detect flat lesions. Blue light cystoscopy (BLC) and narrow band imaging (NBI) cystoscopy are new modalities that could improve the detection of non-muscle invasive bladder cancer (NMIBC) and its recurrence or progression to muscle invasive bladder cancer. We present a systematic review on BLC and NBI cystoscopy for bladder cancer diagnosis and NMIBC follow-up. All available systematic reviews and meta-analyses on cystoscopy published in PubMed® between May 2010 and March 2021 were identified and reviewed. The main endpoints were clinical performance for bladder cancer diagnosis and for recurrence or progression detection during NMIBC follow-up, and additional value compared with cytology and/or WLC. Most of the meta-analyses and systematic reviews published suggest a better sensitivity of BLC and NBI cystoscopy compared to WLC, particularly for the detection of flat lesions (CIS). NBI- and BLC-guided TURBT could decrease the recurrence rates. However, their clinical utility to reduce progression rate and increase survival is still unclear. BLC and NBI cystoscopy are efficient techniques for bladder cancer diagnosis and NMIBC follow-up. However, their clinical benefit remains to be confirmed.

How does narrow band imaging (NBI) plus white light cystoscopy (WLC) compare with WLC alone guidance for adults undergoing transurethral resection of non-muscle invasive bladder cancer?

How does narrow band imaging (NBI) plus white light cystoscopy (WLC) compare with WLC alone guidance for adults undergoing transurethral resection of non-muscle invasive bladder cancer?

Postoperative Recurrent Bladder Tumors Detection by Narrow-Band Imaging Cystoscopy

Postoperative Recurrent Bladder Tumors Detection by Narrow-Band Imaging Cystoscopy

Postoperative Recurrent Bladder Tumors Detection by Narrow-Band Imaging Cystoscopy

Postoperative Recurrent Bladder Tumors Detection by Narrow-Band Imaging Cystoscopy

The role of Narrow-band Imaging Cystoscopy in Non-muscular Invasive Bladder Cancer Management

Cystoscopy is the most common assessment method for the lower urinary tract, with the primary goal of establishing pathology management that can occur at this level. The most used method of performing cystoscopy is with white light, but it can lead to omission of lesions, especially when considering millimetric tumor formations. New light source technologies are under development, such as narrow-band cystoscopy. Overall, we examined a total of 416 patients, known with tumoral lesions, in WLI followed by reassessment in NBI at the same time and transurethral resection of tumor biopsy specimens. In 37.5% of the cases, NBI highlighted 1 to 3 tumors in addition to WLI. In 178 cases, tumor formations were newly discovered, and in 238 patients these were recurrent. Histopathological diagnosis indicated the pTa stage in 67.3% of cases, in 27.64% patients presented with pT1 stage and in 5.04% of cases CIS was identified. In terms of grading, G1 was identified in 205 of the cases, 124 patients presenting G2 and G3 occurred in 87 of the cases.

EDITORIAL COMMENT

A visibly complete transurethral resection (TUR) of non–muscle-invasive bladder tumors is essential to achieve local control and optimize response to intravesical therapy. To remove bladder tumors, they must first be seen. And once detected, how does one verify all tumors have been completely resected? Cystoscopy and TUR are usually performed using white light imaging (WLI). WLI may not reveal every papillary tumor or mucosa involved with carcinoma in situ, leading to incomplete resection and treatment failures. As an adjunct to WLI, cystoscopy enhancement technologies have now entered clinical practice. One of these is narrow band imaging (NBI) cystoscopy. NBI filters white light into 2 narrow bands that enhances contrast between normal mucosa and mucosal vascular tumors (Ref#15 article).

PMD65 - ECONOMIC VALUE OF NARROW BAND IMAGING VERSUS WHITE LIGHT ENDOSCOPY FOR THE MANAGEMENT OF NON-MUSCLE INVASIVE BLADDER CANCER: COST-CONSEQUENCE MODEL

Narrow band imaging (NBI) is a technology used for endoscopic diagnosis and support during the treatment of lesions in non-muscle invasive bladder cancer (NMIBC). NBI has demonstrated improved sensitivity and specificity compared with white-light imaging (WLI), and is associated with lower cancer recurrence. Through these clinical benefits, NBI has the potential to provide cost-savings vs. WLI due to the associated reductions in healthcare resource utilisation. This analysis quantifies the economic benefit of NBI in NMIBC. A cost-consequence analysis was conducted adopting the UK hospital perspective. A cohort of N=100 NMIBC-suspected patients enter the model and receive diagnosis with NBI or WLI cystoscopy. Based on diagnostic accuracy, patients are classified as: true positive (TP), true negative (TN), false positive (FP), or false negative (FN). Patients with a NMIBC diagnosis undergo transurethral resection of bladder tumor (TURBT), while patients diagnosed as cancer-free receive standard monitoring. After one year of observation, patients are stratified into three states: i) cancer-free; ii) recurrence; iii) non-diagnosed NMIBC. Patients with recurrence or non-diagnosed NMIBC can progress from non-invasive to invasive bladder cancer. The model considers hospital costs related to equipment, reprocessing, maintenance, consumables / medication, staff, TURBT, recurrence management and disease progression. A micro-costing approach was adopted to calculate cystoscopy costs. NBI reduced the recurrence rate vs. WLI (16.9% vs. 37.4%, respectively), and resulted in cost-savings of £9,046 (overall costs: £170,577 vs. £179,623, respectively). More NIMBC cases were detected with NBI vs. WLI (81 vs. 69 TP cases, respectively), resulting in increased TURBT costs (£19,309; £127,614 vs. £108,305, respectively). However, increased TURBT costs were offset by the reduction of recurrences, which determined cost-savings of £28,355 (£23,282 with NBI; £51,637 with WLI). This analysis suggests that NBI is dominant vs. WLI for detection and support during the treatment of NMIBC in UK hospitals.

MP08-06 COMBINATION OF RGB AND NARROW BAND IMAGING FOR DISCRIMINATION OF NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2017MP08-06 COMBINATION OF RGB AND NARROW BAND IMAGING FOR DISCRIMINATION OF NON-MUSCLE INVASIVE BLADDER CANCER Kwang Suk Lee, Kyo Chul Koo, Do Kyung Kim, Jongsoo Lee, Jong Won Kim, Jae Yong Jeong, Sung Ku Kang, and Byung Ha Chung Kwang Suk LeeKwang Suk Lee More articles by this author , Kyo Chul KooKyo Chul Koo More articles by this author , Do Kyung KimDo Kyung Kim More articles by this author , Jongsoo LeeJongsoo Lee More articles by this author , Jong Won KimJong Won Kim More articles by this author , Jae Yong JeongJae Yong Jeong More articles by this author , Sung Ku KangSung Ku Kang More articles by this author , and Byung Ha ChungByung Ha Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.293AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated the use of white light imaging (WLI) and narrow-band imaging (NBI) cystoscopy for the detection of bladder cancer. Additional objectives were to provide summary RGB data and to determine a relationship between cancer detection and tumor characteristics. METHODS A prospective double blinded controlled study of NBI was conducted in 102 consecutive patients with definite or suspected bladder cancer after WLI and NBI cystoscopy by 2 urologists. Transurethral targeted biopsies were performed and the histologic outcomes were compared. We analyzed average RGB color on 3x3 pixel of the randomized 3 other points for abnormal lesions and grossly normal in bladder. RESULTS A total of 172 biopsies for suspicious lesions (WLI+/NBI+=145, WLI-/NBI+=27) were taken. The percentage of malignancies in the sites identified only by NBI was 63.0% (17 sites).Of 15 CIS sites, 53.3% was detected by only NBI. The positive predictive value of NBI and WLI were 70.3% and 67.1%, respectively. Bladder washing cytology positive (HR=3.87, p=0.002). grossly papillary feature (HR=6.80, p<0.001) average blue of lesion for WLI (HR=0.96, p=0.006) were significant risk factors for detection of bladder cancer during transurethral targeted biopsy. CONCLUSIONS NBI is a simple and effective method for identifying CIS without the need for dyes. RGB analysis for bladder wall would be helpful for discrimination bladder cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e92 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kwang Suk Lee More articles by this author Kyo Chul Koo More articles by this author Do Kyung Kim More articles by this author Jongsoo Lee More articles by this author Jong Won Kim More articles by this author Jae Yong Jeong More articles by this author Sung Ku Kang More articles by this author Byung Ha Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

P120 - Narrow Band Imaging (NBI) cystoscopy and assisted bipolar TURBT: Preliminary experience

P120 - Narrow Band Imaging (NBI) cystoscopy and assisted bipolar TURBT: Preliminary experience

Narrow band imaging-assisted transurethral resection reduces the recurrence risk of non-muscle invasive bladder cancer: A systematic review and meta-analysis.

ContextCompared with white light imaging (WLI) cystoscopy, narrow band imaging (NBI) cystoscopy could increase the visualization and detection of bladder cancer (BC) at the time of transurethral resection (TUR). NBI cystoscopy could increase the detection of BC, but it remains unclear whether narrow band imaging-assisted transurethral resection (NBI-TUR) could reduce the recurrence risk of non-muscle invasive bladder cancer (NMIBC). Several randomized clinical trials (RCTs) have recently tested the efficacy of NBI-TUR for NMIBC.ObjectiveTo perform a systematic review and meta-analysis of RCTs and evaluate the efficacy of NBI-TUR for NMIBC compared with white light imaging-assisted transurethral resection (WLI-TUR). The end point was recurrence risk.Evidence acquisition: A systematic review of PubMed, Medline, Ovid, Embase, Cochrane and Web of Science was performed in February 2016 and updated in July 2016.Evidence synthesis: Overall, six (n = 1084) of 278 trials were included. Three trials performed narrow band imaging-assisted electro-transurethral resection (NBI-ETUR), and two trials performed narrow band imaging-associated bipolar plasma vaporization (NBI-BPV). The last trial performed narrow band imaging-associated holmium laser resection (NBI-HLR). Statistical analysis was performed using Review Manager software (RevMan v.5.3; The Nordic Cochrane Center, Copenhagen, Denmark). The recurrence risk was compared by calculating risk ratios (RRs) with 95% confidence interval (CIs). Risk ratios with 95% CIs were calculated to compare 3-mo, 1-yr, and 2-yr survival rates. NBI-TUR was associated with improvements in the 3-mo recurrence risk (RR: 0.39; 95% CI, 0.26-0.60; p < 0.0001), 1-yr recurrence risk (RR: 0.52; 95% CI, 0.40-0.67; p < 0.00001) and 2-yr recurrence risk (RR: 0.60; 95% CI, 0.42-0.85; p = 0.004) compared with WLI-TUR.ConclusionsCompared with WLI-TUR, NBI-TUR can reduce the recurrence risk of NMIBC. The results of this review will facilitate the appropriate application of NBI in NMIBC.

Urologic cancer in China

Cancer remains to be the second most common cause of death, and its incidence and mortality rates are increasing in China. According to the 2015 National Central Cancer Registry (NCCR) of China, the incidence of bladder cancer and prostate cancer ranked sixth and seventh, respectively, in male cancers. The majority of prostate cancer patients were diagnosed at an advanced stage. Early diagnosis of prostate cancer is the key to improve prostate cancer survival in China. Radical prostatectomy or radical radiotherapy is the main treatment for localized prostate cancer, and a comprehensive therapy based on androgen deprivation therapy is the treatment for advanced disease. The most common histologic types of bladder cancer in China were urothelial carcinoma, followed by adenocarcinoma and squamous carcinoma. The majority of patients were diagnosed using white-light cystoscopy with biopsy. Fluorescence and narrow-band imaging cystoscopy had additional detection rates and are becoming more popular. Following Chinese guidelines, most non-muscle invasive bladder cancer patients were treated with diagnostic transurethral resection and more than half of the muscle invasive bladder cancer patients were treated with radical cystectomy. Due to the increased detection rate of kidney tumors by ultrasound in physical examination, the number of incidentally diagnosed renal cell carcinoma has increased. Localized kidney cancers are more and more often treated by nephron-sparing surgery. Radical nephrectomy is still the main treatment option for patients with locally advanced renal cell carcinoma. Both laparoscopic and robotic-assisted laparoscopic surgeries have been used in big medical centers. Both testicular cancer and penile cancer have lower incidence levels than that in Europe. As we have an enormous population base, the absolute patient number is big. The diagnosis and treatment follows the Chinese guidelines. In China, both medical professionals and public should concern more on the early diagnosis, as there is not enough cancer prevention information available. Urologists should also take a more active role in educating the population.

A Comparison of the Progression and Recurrence Risk Index in Non-Muscle-Invasive Bladder Tumors Detected by Narrow-Band Imaging Versus White Light Cystoscopy, Based on the EORTC Scoring System.

Background:Transitional cell carcinoma of the bladder, the second most common urologic malignancy, is amenable to early diagnosis. This study presents the potential prognostic benefit for a less invasive modification to the standard endoscopic approach.Objectives:To evaluate the risk index for the progression and recurrence of additional tumors detected with narrow-band imaging (NBI) cystoscopy compared to standard white light imaging (WLI) cystoscopy in non-muscle-invasive bladder cancer (NMIBC), based on the European organization for research and treatment of cancer (EORTC) scoring system.Patients and Methods:Patients with NMIBC, who were scheduled for resection between May 2012 and May 2013, were studied and mapped under NBI and WLI cystoscopy by independent surgeons prior to resection. Detection rates and tumor characteristics, including EORTC progression and the recurrence risk index, were compared.Results:Fifty patients, aged 63.86 ± 10.05 years, were enrolled. The overall detection rate was 98.9% for NBI vs. 89.4% for WLI (P = 0.001), and the false-positive rates were 9.6% and 5.8%, respectively (P = 0.051). Ten tumors were detected by NBI alone, including four grade I tumors, four grade III tumors, and two carcinomas in situ. The tumor progression index was not significantly reduced with NBI compared to WLI (P > 0.05); however, the recurrence index was significantly lower in the NBI group (P < 0.05).Conclusions:NBI cystoscopy improved the detection rate. Although false positives were more common with NBI, this was not statistically significant. NBI found additional aggressive tumors, which underscores the impact of detection in EORTC recurrence risk scoring.

Current status of diagnosis and treatment of bladder cancer in China – Analyses of Chinese Bladder Cancer Consortium database

ObjectiveTo investigate current status of diagnosis and treatment of bladder cancer in China. MethodsA database was generated by Chinese Bladder Cancer Consortium (CBCC). From January 2007 to December 2012, 14,260 cases from 44 CBCC centers were included. Data of diagnosis, treatment and pathology were collected. ResultsThe average age was 63.5 year-old and most patients were male (84.3%). The most common histologic types were urothelial carcinoma (91.4%), adenocarcinoma (1.8%), and squamous carcinoma (1.9%). According to 1973 and 2004 WHO grading system, 42.0%, 41.0%, and 17.0% of patients were grade 1, 2, and 3, and 16.0%, 48.7%, and 35.3% of patients were papillary urothelial neoplasms of low malignant potential, low, and high grade, respectively. Non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) were 25.2% and 74.1%, respectively (0.8% not clear). Carcinoma in situ was only 2.4%. Most patients were diagnosed by white-light cystoscopy with biopsy (74.3%). Fluorescence and narrow band imaging cystoscopy had additional detection rate of 1.0% and 4.0%, respectively. Diagnostic transurethral resection (TUR) provided detection rate of 16.9%. Most NMIBCs were treated with TUR (89.2%). After initial TUR, 2.6% accepted second TUR, and 45.7%, 69.9%, and 58.7% accepted immediate, induced, and maintenance chemotherapy instillation, respectively. Most MIBCs were treated with radical cystectomy (RC, 59.7%). Laparoscopic RCs were 35.1%, while open RC 63.4%. Extended and standard pelvic lymph node dissection were 7% and 66%, respectively. Three most common urinary diversions were orthotopic neobladder (44%), ileal conduit (31%), and ureterocutaneostomy (23%). Only 2.3% of patients accepted neo-adjuvant chemotherapy and only 18% of T3 and T4 patients accepted adjuvant chemotherapy. ConclusionDisease characteristics are similar to international reports, while differences of diagnosis and treatment exist. This study can provide evidences for revisions of the guideline on bladder cancer in China.

Decision Based on Narrow Band Imaging Cystoscopy without a Referential Normal Standard Rather Increases Unnecessary Biopsy in Detection of Recurrent Bladder Urothelial Carcinoma Early after Intravesical Instillation.

PurposeThe purpose of this study was to calculate the operating characteristics of narrowband imaging (NBI) cystoscopy versus traditional white light cystoscopy (WLC) in common clinical scenarios involving suspicion of bladder urothelial carcinoma (UC).Materials and MethodsSixty-three consecutive patients initially underwent WLC and then NBI in a single session for evaluation of microscopic hematuria (group I, n=20), gross hematuria (group II, n=19), and follow-up for prior UC (group III, n=24), by an experienced urologist. All lesions that were abnormal in contrast with adjacent normal mucosa were diagnosed as positive and biopsied.ResultsSixty-six biopsies from 47 patients were performed. Pathologic examination showed 17 cases of UC from 21 sites. While the overall sensitivity of NBI was similar to that of WLC (100% vs. 94.1%), the specificity of NBI was significantly lower than that of WLC (50% vs. 86.9%, p < 0.001), particularly in group III (38.9% vs. 88.9%, p=0.004). Based on identification by NBI only, 23 additional biopsies from 18 cases were performed for identification of one patient with UC, who belonged to group III. In this group, to identify this specific patient, 15 additional biopsies were performed from 10 patients. All seven cases with positive findings from NBI within 2 months after the last intravesical therapy were histologically proven as negative.ConclusionIn evaluation for recurrence early after intravesical instillation, the decision based on NBI increased unnecessary biopsy in the absence of an established standard for judging NBI.

RETRACTED: Randomized Trial of Narrow-band Versus White-light Cystoscopy for Restaging (Second-look) Transurethral Resection of Bladder Tumors

Narrow-band imaging (NBI) cystoscopy detects more bladder tumors than standard white-light imaging (WLI) cystoscopy, but it is unclear whether NBI improves transurethral resection (TUR) of bladder tumors. This study compares 2-yr recurrence-free survival (RFS) of patients with non-muscle-invasive bladder tumors following restaging TUR using NBI or WLI cystoscopy. Patients were randomized 1:1 to undergo NBI-assisted TUR (NBI-TUR) or WLI-assisted TUR (WLI-TUR). The main outcome was number of patients free of tumor recurrence after 2-yr follow-up and 2-yr RFS times. Of 254 patients, 127 underwent NBI-TUR and 127 had WLI-TUR. Within 2 yr, 22% of the patients in the NBI-TUR group recurred compared with 33% after WLI-TUR (p=0.05). The mean RFS time was 22 mo (95% confidence interval [CI], 20-23) for the NBI-TUR group versus 19 mo (95% CI, 18-21) for the WLI-TUR group (p=0.02). Limitations are that this was a single-surgeon study and that a 20% difference in the number of patients free of recurrence was not achieved, suggesting the study was underpowered. In addition, observer bias may have contributed to results because NBI-TUR was performed after both WLI and NBI cystoscopy was used to inspect the bladder. Although the results suggest reduced recurrence rates and improved RFS times after restaging NBI-TUR compared with WLI-TUR, a larger study is needed. Narrow-band imaging enhances visibility of bladder tumors over conventional white-light cystoscopy. This report compares transurethral resection of bladder tumors using narrow-band cystoscopy with white-light cystoscopy. The results show that narrow-band cystoscopy improves surgical removal of bladder tumors, which reduces the frequency of early and later tumor recurrences.

Detection of bladder cancer by narrow band imaging cystoscopy: a meta-analysis

To evaluate the value of narrow band imaging (NBI) cystoscopy in detection of bladder cancer. Literatures on narrow-band imaging cystoscopy in diagnosis of bladder cancer, controlled clinical research was searched in PubMed, Cochrane Library,EMbase, and the Chinese Biomedical Literature Database. The literatures were selected according to the inclusion and exclusion criteria. The Meta-DiSc 1.4 software was used to review management and analysis. The 8 studies met the inclusion criteria. On a per-people analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NBI cystoscopy and white light imaging (WLI) cystoscopy were respectively 0.943 (95%CI: 0.914-0.964) and 0.848 (95%CI: 0.803- 0.885), 0.847 (95%CI: 0.812-0.878) and 0.870 (95%CI: 0.831-0.903), 7.038 (95%CI: 3.357-14.754) and 6.938 (95%CI: 2.052-23.465), 0.054 (95%CI: 0.012-0.237) and 0.181 (95%CI: 0.091-0.361), 185.32 (95%CI: 45.714-751.260) and 42.931 (95%CI: 8.088-227.880). The areas under the curve (AUC) and Q* of NBI cystoscopy and WLI cystoscopy were 0.978 and 0.894, 0.934 and 0.825 respectively. NBI cystoscopy is accurate with high diagnostic precision for diagnosis of bladder cancer. NBI cystoscopy is prior to WLI cystoscopy, but it needs more clinical evidence for further affirmance.

Narrow-Band Imaging Evaluation of Bladder Tumors

Narrow-band imaging (NBI) is a novel optical method designed to enhance visual detection of bladder tumors over conventional white-light imaging (WLI) cystoscopy. Current experience with NBI cystoscopy in evaluating and treating non-muscle-invasive bladder tumors is reviewed. A comprehensive literature search was conducted including all published studies and abstracts investigating NBI cystoscopy in patients with bladder cancer. Comprehensive cystoscopic images are provided to illustrate differences between NBI and WLI cystoscopy. Early experience suggests that NBI cystoscopy detects more bladder tumors than does WLI cystoscopy, and NBI-assisted fulguration and transurethral resection (TUR) appear to result in fewer tumor recurrences. Questions remain, however, such as the following: Does NBI cystoscopy detect high-grade tumors, such as carcinoma in situ, that are missed by WLI cystoscopy? Would false positives lead to an unaccepted number of negative biopsies? And how might observer bias skew results? In addition, a major drawback of current studies is that the quality of cystoscopy and TUR by individual surgeons has not been addressed. Although clinical trials are just beginning, NBI cystoscopy holds promise that this new optical method may improve visualization of bladder tumors over conventional WLI cystoscopy. Further prospective and comparative trials are required to determine whether NBI will play a role in evaluating and treating urothelial tumors in individual patients.

Comparison of narrow-band imaging cystoscopy and white-light imaging cystoscopy to detect bladder lesions – Northern Ireland initial experience

Comparison of narrow-band imaging cystoscopy and white-light imaging cystoscopy to detect bladder lesions – Northern Ireland initial experience

C121 Three-year impact of combined narrow band imaging cystoscopy and bipolar plasma vaporization in large non-muscle invasive bladder tumors' cases – a prospective, randomized comparison to the standard approach

C121 Three-year impact of combined narrow band imaging cystoscopy and bipolar plasma vaporization in large non-muscle invasive bladder tumors' cases – a prospective, randomized comparison to the standard approach

486 Narrow band imaging (NBI) cystoscopy and NBI assisted bipolar TURBT: Does it improve detection rates in low and high risk non muscle invasive bladder cancer? The Rua's experience

486 Narrow band imaging (NBI) cystoscopy and NBI assisted bipolar TURBT: Does it improve detection rates in low and high risk non muscle invasive bladder cancer? The Rua's experience