Current Urology Reports

, 16:58 | Cite as

Role of Narrow Band Imaging in Management of Urothelial Carcinoma

  • Emanuela Altobelli
  • Dimitar V. Zlatev
  • Joseph C. LiaoEmail author
Part of the following topical collections:
  1. Topical Collection on Minimally Invasive Surgery


Urothelial carcinoma of the bladder and upper tract is primarily diagnosed by white light endoscopy, which has well-known limitations that contribute to the increased risk of tumor recurrence and progression. Narrow band imaging (NBI) is an optical imaging technology that facilitates detection of tumor vasculature and differentiation of benign urothelium from neoplastic tissue. For urothelial carcinoma, NBI may be utilized in a variety of clinical settings, including office cystoscopy for initial identification and surveillance, transurethral resection for pathological diagnosis, and ureteroscopic management of upper tract lesions. Early evidence suggests that NBI increases the detection of urothelial carcinoma in the bladder and upper tract, including flat high-grade lesions such as carcinoma-in-situ that are a diagnostic challenge under white light. NBI also appears to improve the quality of transurethral resection and thereby reduce the frequency of tumor recurrence.


Narrow band imaging Urothelial carcinoma White light cystoscopy Diagnostic ureteroscopy Transurethral resection 


Compliance with Ethics Guidelines

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29. doi: 10.3322/caac.21208.PubMedCrossRefGoogle Scholar
  2. 2.
    Burger M, Catto JW, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol. 2013;63(2):234–41. doi: 10.1016/j.eururo.2012.07.033.PubMedCrossRefGoogle Scholar
  3. 3.
    Roupret M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R, et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. European Association of Urology Guideline Group for urothelial cell carcinoma of the upper urinary tract. Actas Urol Esp. 2012;36(1):2–14. doi: 10.1016/j.acuro.2011.09.001.PubMedCrossRefGoogle Scholar
  4. 4.
    Kirkali Z, Chan T, Manoharan M, Algaba F, Busch C, Cheng L, et al. Bladder cancer: epidemiology, staging and grading, and diagnosis. Urology. 2005;66(6 Suppl 1):4–34. doi: 10.1016/j.urology.2005.07.062.PubMedCrossRefGoogle Scholar
  5. 5.
    Morgan TM, Keegan KA, Clark PE. Bladder cancer. Curr Opin Oncol. 2011;23(3):275–82. doi: 10.1097/CCO.0b013e3283446a11.PubMedCrossRefGoogle Scholar
  6. 6.
    Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49(3):466–5. doi: 10.1016/j.eururo.2005.12.031. discussion 75–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Olgac S, Mazumdar M, Dalbagni G, Reuter VE. Urothelial carcinoma of the renal pelvis: a clinicopathologic study of 130 cases. Am J Surg Pathol. 2004;28(12):1545–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Fradet Y, Grossman HB, Gomella L, Lerner S, Cookson M, Albala D, et al. A comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of carcinoma in situ in patients with bladder cancer: a phase III, multicenter study. J Urol. 2007;178(1):68–73. doi: 10.1016/j.juro.2007.03.028. discussion.PubMedCrossRefGoogle Scholar
  9. 9.
    Jocham D, Witjes F, Wagner S, Zeylemaker B, van Moorselaar J, Grimm MO, et al. Improved detection and treatment of bladder cancer using hexaminolevulinate imaging: a prospective, phase III multicenter study. J Urol. 2005;174(3):862–6. doi: 10.1097/01.ju.0000169257.19841.2a. discussion 6.PubMedCrossRefGoogle Scholar
  10. 10.
    Cina SJ, Epstein JI, Endrizzi JM, Harmon WJ, Seay TM, Schoenberg MP. Correlation of cystoscopic impression with histologic diagnosis of biopsy specimens of the bladder. Hum Pathol. 2001;32(6):630–7. doi: 10.1053/hupa.2001.24999.PubMedCrossRefGoogle Scholar
  11. 11.
    Babjuk M, Soukup V, Petrik R, Jirsa M, Dvoracek J. 5-aminolaevulinic acid-induced fluorescence cystoscopy during transurethral resection reduces the risk of recurrence in stage Ta/T1 bladder cancer. BJU Int. 2005;96(6):798–802. doi: 10.1111/j.1464-410X.2004.05715.x.PubMedCrossRefGoogle Scholar
  12. 12.
    Daniltchenko DI, Riedl CR, Sachs MD, Koenig F, Daha KL, Pflueger H, et al. Long-term benefit of 5-aminolevulinic acid fluorescence assisted transurethral resection of superficial bladder cancer: 5-year results of a prospective randomized study. J Urol. 2005;174(6):2129–33. doi: 10.1097/01.ju.0000181814.73466.14. discussion 33.PubMedCrossRefGoogle Scholar
  13. 13.
    Cheng L, Neumann RM, Weaver AL, Cheville JC, Leibovich BC, Ramnani DM, et al. Grading and staging of bladder carcinoma in transurethral resection specimens. Correlation with 105 matched cystectomy specimens. Am J Clin Pathol. 2000;113(2):275–9. doi: 10.1309/94b6-8vfb-mn9j-1nf5.PubMedCrossRefGoogle Scholar
  14. 14.
    Liu JJ, Droller MJ, Liao JC. New optical imaging technologies for bladder cancer: considerations and perspectives. J Urol. 2012;188(2):361–8. doi: 10.1016/j.juro.2012.03.127.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Herr H, Donat M, Dalbagni G, Taylor J. Narrow-band imaging cystoscopy to evaluate bladder tumours–individual surgeon variability. BJU Int. 2010;106(1):53–5. doi: 10.1111/j.1464-410X.2009.09119.x.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Bryan RT, Shah ZH, Collins SI, Wallace DM. Narrow-band imaging flexible cystoscopy: a new user’s experience. J Endourol / Endourol Soc. 2010;24(8):1339–43. doi: 10.1089/end.2009.0598.CrossRefGoogle Scholar
  17. 17.
    Bryan RT, Billingham LJ, Wallace DM. Narrow-band imaging flexible cystoscopy in the detection of recurrent urothelial cancer of the bladder. BJU Int. 2008;101(6):702–5. doi: 10.1111/j.1464-410X.2007.07317.x. discussion 5–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Cauberg EC, Kloen S, Visser M, de la Rosette JJ, Babjuk M, Soukup V, et al. Narrow band imaging cystoscopy improves the detection of non-muscle-invasive bladder cancer. Urology. 2010;76(3):658–63. doi: 10.1016/j.urology.2009.11.075.PubMedCrossRefGoogle Scholar
  19. 19.
    Chen G, Wang B, Li H, Ma X, Shi T, Zhang X. Applying narrow-band imaging in complement with white-light imaging cystoscopy in the detection of urothelial carcinoma of the bladder. Urol Oncol. 2013;31(4):475–9. doi: 10.1016/j.urolonc.2011.02.009.PubMedCrossRefGoogle Scholar
  20. 20.
    Geavlete B, Jecu M, Multescu R, Geavlete P. Narrow-band imaging cystoscopy in non-muscle-invasive bladder cancer: a prospective comparison to the standard approach. Ther Adv Urol. 2012;4(5):211–7. doi: 10.1177/1756287212454181.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Shen YJ, Zhu YP, Ye DW, Yao XD, Zhang SL, Dai B, et al. Narrow-band imaging flexible cystoscopy in the detection of primary non-muscle invasive bladder cancer: a “second look” matters? Int Urol Nephrol. 2012;44(2):451–7. doi: 10.1007/s11255-011-0036-5.PubMedCrossRefGoogle Scholar
  22. 22.
    Tatsugami K, Kuroiwa K, Kamoto T, Nishiyama H, Watanabe J, Ishikawa S, et al. Evaluation of narrow-band imaging as a complementary method for the detection of bladder cancer. J Endourol / Endourol Soc. 2010;24(11):1807–11. doi: 10.1089/end.2010.0055.CrossRefGoogle Scholar
  23. 23.
    Li K, Lin T, Fan X, Duan Y, Huang J. Diagnosis of narrow-band imaging in non-muscle-invasive bladder cancer: a systematic review and meta-analysis. Int J Urol. 2013;20(6):602–9. doi: 10.1111/j.1442-2042.2012.03211.x.PubMedCrossRefGoogle Scholar
  24. 24.
    Zheng C, Lv Y, Zhong Q, Wang R, Jiang Q. Narrow band imaging diagnosis of bladder cancer: systematic review and meta-analysis. BJU Int. 2012;110(11 Pt B):E680-7. doi: 10.1111/j.1464-410X.2012.11500.x.
  25. 25.
    Herr HW, Donat SM. A comparison of white-light cystoscopy and narrow-band imaging cystoscopy to detect bladder tumour recurrences. BJU Int. 2008;102(9):1111–4. doi: 10.1111/j.1464-410X.2008.07846.x.PubMedCrossRefGoogle Scholar
  26. 26.
    Geavlete B, Multescu R, Georgescu D, Stanescu F, Jecu M, Geavlete P. Narrow band imaging cystoscopy and bipolar plasma vaporization for large nonmuscle-invasive bladder tumors—results of a prospective, randomized comparison to the standard approach. Urology. 2012;79(4):846–51. doi: 10.1016/j.urology.2011.08.081.PubMedCrossRefGoogle Scholar
  27. 27.
    Herr HW, Donat SM. Reduced bladder tumour recurrence rate associated with narrow-band imaging surveillance cystoscopy. BJU Int. 2011;107(3):396–8. doi: 10.1111/j.1464-410X.2010.09547.x.PubMedCrossRefGoogle Scholar
  28. 28.•
    Naselli A, Introini C, Timossi L, Spina B, Fontana V, Pezzi R, 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. Eur Urol. 2012;61(5):908–13. doi: 10.1016/j.eururo.2012.01.018. This randomized prospective trial assessed the impact of NBI on 1-year bladder cancer recurrence risk and found that TUR performed under NBI significantly reduced recurrence risk in comparison to WLC. PubMedCrossRefGoogle Scholar
  29. 29.•
    Herr HW. Randomized trial of narrow-band versus white-light cystoscopy for restaging (second-look) transurethral resection of bladder tumors. Eur Urol. 2014. doi: 10.1016/j.eururo.2014.06.049. This randomized controlled trial showed that NBI-assisted TUR of bladder tumors significantly reduced the recurrence rate and improved recurrence-free survival when compared to WLC-assisted TUR. Google Scholar
  30. 30.
    de la Rosette J, Gravas S. A multi-center, randomized international study to compare the impact of narrow band imaging versus white light cystoscopy in the recurrence of bladder cancer. J Endourol / Endourol Soc. 2010;24(5):660–1. doi: 10.1089/end.2010.1510.Google Scholar
  31. 31.•
    Naito S, van Rees Vellinga S, de la Rosette J. Global randomized narrow band imaging versus white light study in nonmuscle invasive bladder cancer: accession to the first milestone-enrollment of 600 patients. J Endourol / Endourol Soc. 2013;27(1):1–3. doi: 10.1089/end.2012.1556. This is an update on the international multicenter randomized controlled trial launched in 2010 with the aim to compare the recurrence rate at 1 year after NBI- and WLC-assisted TUR in patients with non-muscle-invasive bladder cancer. The study includes 24 centers and is nearing completion of goal enrollment of 1000 patients. CrossRefGoogle Scholar
  32. 32.
    Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Comperat E, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol. 2013;64(4):639–53. doi: 10.1016/j.eururo.2013.06.003.PubMedCrossRefGoogle Scholar
  33. 33.
    Herr HW. Narrow-band imaging cystoscopy to evaluate the response to bacille Calmette-Guerin therapy: preliminary results. BJU Int. 2010;105(3):314–6. doi: 10.1111/j.1464-410X.2009.08788.x.PubMedCrossRefGoogle Scholar
  34. 34.
    Traxer O, Geavlete B, de Medina SG, Sibony M, Al-Qahtani SM. Narrow-band imaging digital flexible ureteroscopy in detection of upper urinary tract transitional-cell carcinoma: initial experience. J Endourol / Endourol Soc. 2011;25(1):19–23. doi: 10.1089/end.2009.0593.CrossRefGoogle Scholar
  35. 35.
    Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester R, Burger M, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013;63(6):1059–71. doi: 10.1016/j.eururo.2013.03.032.PubMedCrossRefGoogle Scholar
  36. 36.
    Cornu JN, Roupret M, Carpentier X, Geavlete B, de Medina SG, Cussenot O, et al. Oncologic control obtained after exclusive flexible ureteroscopic management of upper urinary tract urothelial cell carcinoma. World J Urol. 2010;28(2):151–6. doi: 10.1007/s00345-009-0494-x.PubMedCrossRefGoogle Scholar
  37. 37.
    Lucas SM, Svatek RS, Olgin G, Arriaga Y, Kabbani W, Sagalowsky AI, et al. Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery. BJU Int. 2008;102(2):172–6. doi: 10.1111/j.1464-410X.2008.07535.x.PubMedCrossRefGoogle Scholar
  38. 38.
    Roupret M, Traxer O, Tligui M, Conort P, Chartier-Kastler E, Richard F, et al. Upper urinary tract transitional cell carcinoma: recurrence rate after percutaneous endoscopic resection. Eur Urol. 2007;51(3):709–13. doi: 10.1016/j.eururo.2006.07.019. discussion 14.PubMedCrossRefGoogle Scholar
  39. 39.
    Lapini A, Minervini A, Masala A, Schips L, Pycha A, Cindolo L, et al. A comparison of hexaminolevulinate (Hexvix((R))) fluorescence cystoscopy and white-light cystoscopy for detection of bladder cancer: results of the HeRo observational study. Surg Endosc. 2012;26(12):3634–41. doi: 10.1007/s00464-012-2387-0.PubMedCrossRefGoogle Scholar
  40. 40.
    Rink M, Babjuk M, Catto JW, Jichlinski P, Shariat SF, Stenzl A, et al. Hexyl aminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: a critical review of the current literature. Eur Urol. 2013;64(4):624–38. doi: 10.1016/j.eururo.2013.07.007.PubMedCrossRefGoogle Scholar
  41. 41.
    Kausch I, Sommerauer M, Montorsi F, Stenzl A, Jacqmin D, Jichlinski P, et al. Photodynamic diagnosis in non-muscle-invasive bladder cancer: a systematic review and cumulative analysis of prospective studies. Eur Urol. 2010;57(4):595–606. doi: 10.1016/j.eururo.2009.11.041.PubMedCrossRefGoogle Scholar
  42. 42.
    Somani BK, Moseley H, Eljamel MS, Nabi G, Kata SG. Photodynamic diagnosis (PDD) for upper urinary tract transitional cell carcinoma (UT-TCC): evolution of a new technique. Photodiagnosis Photodyn Ther. 2010;7(1):39–43. doi: 10.1016/j.pdpdt.2009.12.005.PubMedCrossRefGoogle Scholar
  43. 43.
    Chang TC, Liu JJ, Liao JC. Probe-based confocal laser endomicroscopy of the urinary tract: the technique. J Vis Exp JoVE. 2013;(71):e4409. doi: 10.3791/4409.
  44. 44.
    Sonn GA, Jones SN, Tarin TV, Du CB, Mach KE, Jensen KC, et al. Optical biopsy of human bladder neoplasia with in vivo confocal laser endomicroscopy. J Urol. 2009;182(4):1299–305. doi: 10.1016/j.juro.2009.06.039.PubMedCrossRefGoogle Scholar
  45. 45.
    Chang TC, Liu JJ, Hsiao ST, Pan Y, Mach KE, Leppert JT, et al. Interobserver agreement of confocal laser endomicroscopy for bladder cancer. J Endourol / Endourol Soc. 2013;27(5):598–603. doi: 10.1089/end.2012.0549.CrossRefGoogle Scholar
  46. 46.
    Goh AC, Tresser NJ, Shen SS, Lerner SP. Optical coherence tomography as an adjunct to white light cystoscopy for intravesical real-time imaging and staging of bladder cancer. Urology. 2008;72(1):133–7. doi: 10.1016/j.urology.2008.02.002.PubMedCrossRefGoogle Scholar
  47. 47.
    Hermes B, Spoler F, Naami A, Bornemann J, Forst M, Grosse J, et al. Visualization of the basement membrane zone of the bladder by optical coherence tomography: feasibility of noninvasive evaluation of tumor invasion. Urology. 2008;72(3):677–81. doi: 10.1016/j.urology.2008.02.062.PubMedCrossRefGoogle Scholar
  48. 48.
    Karl A, Stepp H, Willmann E, Buchner A, Hocaoglu Y, Stief C, et al. Optical coherence tomography for bladder cancer—ready as a surrogate for optical biopsy? Results of a prospective mono-centre study. Eur J Med Res. 2010;15(3):131–4.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Bus MT, Muller BG, de Bruin DM, Faber DJ, Kamphuis GM, van Leeuwen TG, et al. Volumetric in vivo visualization of upper urinary tract tumors using optical coherence tomography: a pilot study. J Urol. 2013;190(6):2236–42. doi: 10.1016/j.juro.2013.08.006.PubMedCrossRefGoogle Scholar
  50. 50.
    Matin SF, Kamat AM, Grossman HB. High-frequency endoluminal ultrasonography as an aid to the staging of upper tract urothelial carcinoma: imaging findings and pathologic correlation. J Ultrasound Med Offic J Am Instit Ultrasound Med. 2010;29(9):1277–84.Google Scholar
  51. 51.
    Gravas S, Stenzl A. The Storz professional image enhancement system (SPIES) nonmuscle-invasive bladder cancer study: a multicenter international randomized controlled study. J Endourol / Endourol Soc. 2014;28(11):1254–5. doi: 10.1089/end.2014.1651.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Emanuela Altobelli
    • 1
    • 2
  • Dimitar V. Zlatev
    • 1
  • Joseph C. Liao
    • 1
    • 3
    Email author
  1. 1.Department of UrologyStanford University School of MedicineStanfordUSA
  2. 2.Department of UrologyCampus Biomedico UniversityRomeItaly
  3. 3.Veterans Affairs Palo Alto Health Care SystemPalo AltoUSA

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