Narrow-Band Imaging (NBI)

  • Seiji NaitoEmail author


Cystoscopy and transurethral resection (TUR) using white light (WL) has been used as a standard procedure for diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). However, WL cystoscopy cannot always effectively identify small tumor or high grade flat lesions, carcinoma in situ (CIS). Small tumors can be frequently missed resulting in a high rate of residual tumors after WL-assisted TUR, and deficient visualization of tumor borders or associated CIS may lead to incomplete resection. Such oversights of small tumors or incomplete resections are considered to be a cause of the high incidence of intravesical recurrence after WL-assisted TUR.

Recently, Narrow-band imaging (NBI) has been developed as a new technology to overcome such shortcomings of WL cystoscopy or WL-assisted TUR. NBI devices filter out the red spectrum from WL, leaving the resultant blue (415 nm) and green (540 nm) spectra. These specific wavelengths penetrate only the surface of the bladder tissue, and are strongly absorbed by hemoglobin. Consequently, high vessel contrast and delicate tissue surface structure can be obtained without any medication. NBI can be used easily and safely in an outpatient clinic for cystoscopy, and in an operating room for TUR. NBI increases the detection of bladder tumors including CIS without any significant increase in false-positive rates that would lead to unnecessary negative biopsies. NBI also may improve the quality of TUR and consequently reduce the subsequent tumor recurrence particularly in low-risk patients.

Thus, NBI is a promising technology that facilitates the diagnosis and treatment of NMIBC.


Narrow-band imaging Non-muscle invasive bladder cancer Transurethral resection 


  1. Bryan RT, Billingham LJ, Wallacet MA. Narrow-band imaging flexible cystoscopy in the detection of recurrent urothelial cancer of the bladder. BJU Int. 2007;191:702–6.Google Scholar
  2. Bryan RT, Shah ZH, Collins SI, et al. Narrowband imaging flexible cystoscopy: a new user’s experience. J Endourol. 2010;24:1339–43.CrossRefGoogle Scholar
  3. Burger M, Catto JW, Dalbagni G, et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol. 2013;63:234–41.CrossRefGoogle Scholar
  4. Cauberg ECC, Kloen S, Visser M, et al. Narrow band imaging cystoscopy improves the detection of non-muscle-invasive bladder cancer. Urology. 2010;76:658–63.CrossRefGoogle Scholar
  5. Cauberg ECC, Mamoulakis C, de la Rosette JJMCH, et al. Narrow band imaging-assisted transurethral resection for non-muscle invasive bladder cancer significantly reduces residual tumor rate. World J Urol. 2011;29:503–9.CrossRefGoogle Scholar
  6. Chen G, Wang B, Li H, et al. Applying narrow-band imaging in complement with white-light imaging cystoscopy in the detection of urothelial carcinoma of the bladder. Urol Oncol. 2013;31:475–9.CrossRefGoogle Scholar
  7. Ferlay J, Soerjomataram I, Dikshit R, et al. GLOBOCAN 2012 v.1.0, estimated cancer incidence, mortality and prevalence worldwide in 2012. Lyon: International Agency for Research on Cancer; 2013.Google Scholar
  8. Geavlete B, Jecu M, Multescu R, et al. Narrow-band imaging cystoscopy in non-muscle-invasive bladder cancer: a prospective comparison to the standard approach. Ther Adv Urol. 2012;4:211–7.CrossRefGoogle Scholar
  9. Herr HW, Donat SM. A comparison of white-light cystoscopy and narrow-band imaging cystoscopy to detect bladder tumour recurrences. BJU Int. 2008;102:1111–4.CrossRefGoogle Scholar
  10. Herr HW, Donat SM. Reduced bladder tumor recurrence rate associated with narrow-band imaging surveillance cystectomy. BJU Int. 2010;107:396–8.CrossRefGoogle Scholar
  11. Herr H, Donat M, Dalbagni G, et al. Narrow-band imaging cystoscopy to evaluate bladder tumours—individual surgeon variability. BJU Int. 2009;106:53–5.CrossRefGoogle Scholar
  12. Li K, Lin T, Fan X, et al. Diagnosis of narrow-band imaging in non-muscle-invasive bladder cancer: a systematic review and meta-analysis. Int J Urol. 2013;20:602–9.CrossRefGoogle Scholar
  13. Naito S, Algaba F, Babjuk M, et al. The clinical research office of endourological society (CROES) multicentre randomized trial of narrow band imaging-assisted transurethral resection of bladder tumor (TURBT) versus conventional white light imaging-assisted TURBT in primary non-muscle-invasive bladder cancer patients: trial protocol and 1-year results. Eur Urol. 2016;70:506–15.CrossRefGoogle Scholar
  14. Naselli A, Introini C, Timossi L, 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;61:908–13.CrossRefGoogle Scholar
  15. Sylvester RJ, van der Meiden APM, Oosterlinck W, 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):466–77.CrossRefGoogle Scholar
  16. Tatsugami K, Kuroiwa K, Kamoto T, et al. Evaluation of narrow-band imaging as a complementary method for the detection of bladder cancer. J Endourol. 2010;24:1807–11.CrossRefGoogle Scholar
  17. Ye Z, Hu J, Song X, et al. A comparison of NBI and WLI cystoscopy in detecting non-muscle-invasive bladder cancer: a prospective, randomized and multi-center study. Sci Rep. 2015;5:10905.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of UrologyHarasanshin HospitalFukuokaJapan

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