White-light Imaging Cystoscopy Research Articles

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 ...

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.

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

Diagnosis of narrow‐band imaging in non‐muscle‐invasive bladder cancer: A systematic review and meta‐analysis

The objective was to evaluate the diagnostic accuracy of cystoscopy assisted by narrow-band imaging compared with white-light imaging for non-muscle-invasive bladder cancer. 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. Seven studies with prospectively collected data including a total of 1040 patients were identified, and 611 patients with 1476 tumors were detected by biopsy. In the patient- and tumor-level analysis, an additional 17% of patients (95% confidence interval, 10-25%) and an additional 24% of tumors (95% confidence interval, 17-31%) were detected by narrow-band imaging, respectively. In the patient- and tumor-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 tumor 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 tumor level did not differ significantly between the two techniques. Cystoscopy assisted by narrow-band imaging detects more patients and tumors 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.

Applying narrow-band imaging in complement with white-light imaging cystoscopy in the detection of urothelial carcinoma of the bladder

ObjectivesTo investigate the value of narrow-band imaging (NBI) flexible cystoscopy in the detection of urothelial carcinoma (UC) of the bladder. Materials and methodsClinical data of 179 patients with suspected UC, who presented with gross hematuria, were collected at China PLA General Hospital from January 2009 to August 2010. These patients underwent white-light imaging (WLI) cystoscopy followed by NBI. The tumors were visualized, imaged, and recorded. Suspected UCs were biopsied or treated by transurethral resection, and then sent for pathologic examination. Detection results for NBI and WLI were compared. ResultsWLI and NBI confirmed UC in 143 patients; a total of 285 tumors were detected. The patient-level detection rates for NBI and WLI were 97.9% (140/143) and 88.8% (127/143), respectively (P = 0.002). The patient-level false-positive detection rates for NBI and WLI were 21.8% (39/179) and 29.1% (52/179), respectively (P = 0.12). NBI detected a total of 59 additional tumors (17.2%; 34pTa, 17pT1, 3pT2, and 5pTis) in 44 of 143 patients (30.8%). NBI found 1 additional tumor in 34 cases, 2 additional tumors in 6 cases, 3 additional tumors in 3 cases, and 4 additional tumors in 1 case. The mean ± SD (range) number of identified UCs per patient was 1.97 ± 0.67 (1–5) for NBI and 1.78 ± 0.53 (1–4) for WLI (P = 0.01). The tumor-level detection rates for NBI and WLI were 96.8% and 79.3%, respectively (P < 0.001). ConclusionsCompared with WLI, NBI improves UC detection. It has a higher rate of detection and a comparative rate of false-positive detection. NBI is simple and requires no dyeing. It can be conveniently applied to complement WLI.

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.

Narrow-Band Imaging Flexible Cystoscopy: A New User's Experience

We and others have demonstrated previously an improved detection rate for bladder cancer recurrences with narrow-band imaging (NBI) flexible cystoscopy when compared with conventional white-light imaging (WLI) flexible cystoscopy. We investigated whether a "new user" of NBI flexible cystoscopy, previously unfamiliar with this technique, could reproduce these results. The same protocol from our previous study was used by a new user (ZHS) for this second study at The Queen Elizabeth Hospital, Birmingham, United Kingdom. NBI flexible cystoscopy was performed on 23 patients with known recurrences of urothelial cancer (UC) of the bladder after initial conventional WLI flexible cystoscopy with the same switchable Olympus Lucera sequential red/green/blue instrument. NBI detected 15 additional UCs in 8 of the 23 (35%) patients: Six of these patients had one additional UC, one had four additional UCs, and one had five additional UCs when compared with WLI, with a mean of 0.65 additional UCs per patient (standard deviation 1.30; Wilcoxon P = 0.01). When this second series is compared with our first published series, there is no statistical evidence that the excess number of UCs detected by NBI is different (Wilcoxon [unpaired] signed-rank test P = 0.74), which suggests that there is no difference between a new user and an experienced user in the application of NBI. We and others continue to demonstrate a significantly improved detection rate of bladder UCs with NBI cystoscopy when compared with conventional WLI cystoscopy, even for new users previously unfamiliar with this technology.

1163 NARROW-BAND IMAGING FLEXIBLE CYSTOSCOPY IN THE DETECTION OF NEW NON-MUSCLE INVASIVE BLADDER CANCER: A RANDOMIZED STUDY

You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20101163 NARROW-BAND IMAGING FLEXIBLE CYSTOSCOPY IN THE DETECTION OF NEW NON-MUSCLE INVASIVE BLADDER CANCER: A RANDOMIZED STUDY Yijun Shen, Yiping Zhu, Dingwei Ye, Xudong Yao, Shilin Zhang, Bo Dai, Hailiang Zhang, Yao Zhu, Guohai Shi, Chunguang Ma, and Wenjun Xiao Yijun ShenYijun Shen More articles by this author , Yiping ZhuYiping Zhu More articles by this author , Dingwei YeDingwei Ye More articles by this author , Xudong YaoXudong Yao More articles by this author , Shilin ZhangShilin Zhang More articles by this author , Bo DaiBo Dai More articles by this author , Hailiang ZhangHailiang Zhang More articles by this author , Yao ZhuYao Zhu More articles by this author , Guohai ShiGuohai Shi More articles by this author , Chunguang MaChunguang Ma More articles by this author , and Wenjun XiaoWenjun Xiao More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.663AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Narrow-band imaging(NBI) is an optical image enhancement technique to enhance the contrast between mucosal surfaces and microvascular structures without dyes. Although it is now frequently used in gastrointestinal endoscopy, there are still some controversies about its benefit in the detection of urinary bladder cancer. One of the limitations of previous study is the possible observer bias as white-light imaging (WLI) and NBI were performed subsequently by the same urologist. This study was designed to investigate the detection rate of new non-muscle invasive bladder cancer(NIMBC) between NBI and WLI flexible cystoscopy with a randomized image sequential paradigm. METHODS Between February 2009 and October 2009, NBI and WLI flexible cystoscopy with the same instrument (Olympus Lucera sequential endoscopy system)were both performed on 45 patients with suspected new NIMBC in a randomized image sequential paradigm with the same observing time to avoid the observer bias. Biopsies obtained by NBI and WLI were examined separately for pathology. After biopsy, a standard TUR with resected samples was performed to show presence of tumors or not. RESULTS 41 patients (91.1%) were pathologically NIMBC. Of these 22 were Ta, 14 were T1, 5 were Tis. 89 Of 110 biopsied lesions were found tumor under WLI while 113 of 142 were under NBI. The sensitivity of WLI vs NBI for detecting bladder tumors in all 45 patients was 80.5% vs 97.6% (P<0.05), the specificity 50% vs 75% (P<0.05), the accuracy 77.8% vs 95.6% (P<0.05), and the AUC was 0.652 vs 0.863(P>0.05). All 5 Tis were detected by NBI while 2 missed by WLI. NBI detected 24 additional cancer lesions in 15 of 41 patients, as compared with WLI (P<0.05). CONCLUSIONS NBI flexible cystoscopy improved the detection of NIMBC over standard WLI cystoscopy, contributing to its high value in the clinical practice of bladder cancer. Shanghai, People's Republic of China© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e450-e451 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yijun Shen More articles by this author Yiping Zhu More articles by this author Dingwei Ye More articles by this author Xudong Yao More articles by this author Shilin Zhang More articles by this author Bo Dai More articles by this author Hailiang Zhang More articles by this author Yao Zhu More articles by this author Guohai Shi More articles by this author Chunguang Ma More articles by this author Wenjun Xiao More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Narrow Band Imaging Cystoscopy Improves the Detection of Non–muscle-invasive Bladder Cancer

To determine whether narrow band imaging (NBI) improves detection of non-muscle-invasive bladder cancer over white-light imaging (WLI) cystoscopy. We conducted a prospective, within-patient comparison on 103 consecutive procedures on 95 patients scheduled for (re-) transurethral resection of a bladder tumor (84) or bladder biopsies (19) in the Academic Medical Center, Amsterdam (September 2007-July 2009) and in the General Faculty Hospital, Prague (January 2009-July 2009). WLI and NBI cystoscopy were subsequently performed by different surgeons who independently indicated all tumors and suspect areas on a bladder diagram. The lesions identified were resected/biopsied and sent for histopathological examination. Number of patients with additional tumors detected by WLI and NBI were calculated; mean number of urothelial carcinomas (UCs) per patient, detection rates, and false-positive rates of both techniques were compared. A total of 78 patients had a confirmed UC; there were 226 tumors in total. In 28 (35.9%) of these patients, a total of 39 additional tumors (17.3%) (26pTa, 6pT1, 1pT2, 6pTis) were detected by NBI, whereas 4 additional tumors (1.8%) (1pTa, 1pT1, 2pTis) within 3 patients (2.9%) were detected by WLI. The mean (SD, range) number of UCs per patient identified by NBI was 2.1 (2.6, 0-15), vs 1.7 (2.3, 0-15) by WLI (P <.001). The detection rate of NBI was 94.7% vs 79.2% for WLI (P <.001). The false-positive rate of NBI and WLI was 31.6% and 24.5%, respectively (P <.001). NBI cystoscopy improves the detection of primary and recurrent nonmuscle invasive bladder cancer over WLI. However, further validation of the technique with comparative studies is required.

A comparison of white‐light cystoscopy and narrow‐band imaging cystoscopy to detect bladder tumour recurrences

To determine whether narrow-band imaging (NBI) cystoscopy enhances the detection of non-muscle-invasive bladder tumours over standard white-light imaging (WLI) cystoscopy, as surveillance WLI is the standard method used to diagnose patients with recurrent bladder tumours, but they can be missed by WLI cystoscopy, possibly accounting for early recurrences. We evaluated 427 patients for recurrent bladder tumours by WLI cystoscopy, followed by NBI cystoscopy as a further procedure, using the same video-cystoscope. Recurrent tumours visualized by WLI or NBI cystoscopy were mapped, imaged, biopsied and subsequently treated by transurethral resection (TUR) or fulguration. Biopsies or TUR specimens obtained by WLI and NBI were examined separately for presence of tumour. In all, 103 patients (24%) had tumour recurrences; 90 (87%) were detected by both WLI and NBI and another 13 (100%) only by NBI cystoscopy. NBI detected extra papillary tumours or more extensive carcinoma in situ in 58 (56%) patients found to have recurrences. The mean number of recurrent tumours visualized on WLI cystoscopy was 2.3, vs to 3.4 seen on NBI cystoscopy (P = 0.01). NBI cystoscopy improved the detection of recurrent non-muscle-invasive bladder tumours over standard WLI cystoscopy.