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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:
[email protected], [email protected] (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: [email protected]
*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.
Postbox 10 49 08, 20034 Hamburg, GermanyWendenstrasse 14–18, 20097 Hamburg, GermanyPhone: +49 (0)40 237 730, Fax: +49 (0)40 230 761www.olympus-europa.com