Narrow-band Imaging – Shifting the Paradigm in the Management of Non-muscle-invasive Bladder Cancer?

Angelo Naselli, Paolo Puppo
European Urological Review, 2011;6(2):103-106
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Abstract

Narrow-band imaging (NBI) is an optical enhancement technology for endoscopy which consists of filtering standard white light into two bandwidths of illumination centred on 415 nm (blue) and 540 nm (green). The light obtained is absorbed by haemoglobin and penetrates only the superficial layers of tissue, increasing the visibility of capillaries and superficial tissue structures. A non-systematic review of the literature on NBI in bladder cancer management was performed. Experience with NBI is as yet limited to small series of patients with suspected or overt bladder cancer who were examined sequentially by means of standard white-light and then NBI cystoscopy. Notwithstanding the limits of observational studies among patients, it emerges strongly that NBI is able to increase detection of bladder cancer within patients and, more intriguingly, of patients with bladder cancer. The enhanced detection may translate into an improvement in the recurrence rate/management of bladder cancer by treating/biopsying otherwise overlooked cancers or more extensive tumour fields.

Support: The publication of this article was funded by Olympus Europa GmbH. The views and opinions expressed are those of the authors and not necessarily those of Olympus Europa GmbH.
Keywords
Urinary bladder neoplasms, cystoscopy, recurrence, diagnostic imaging
Disclosure The authors have no conflicts of interest to declare.
Received: July 16, 2011 Accepted September 02, 2011
Correspondence: Angelo Naselli, National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132 Genoa, Italy. E: angelo.naselli@libero.it
What is Narrow-band Imaging?

Narrow-band imaging (NBI) is an emerging optical enhancement technology for endoscopy. NBI provides an improved view of vasculature and superficial tissue structures of the mucosa with respect to standard white-light examination.

The principle of NBI is explained in an experimental work published in 2004. The authors employed five narrow-band illuminations and three broad-band illuminations to examine the mucosa of the underside of the human tongue. Results showed that the vascular pattern of pathological conditions was dependent on the centre wavelength and the bandwidth of illumination. Particularly by narrowing the band of illumination to 415 ± 30 nm, the contrast among vasculature and mucosa was greatly enhanced.1

Currently, NBI consists of two bandwidths of illumination centred on 415 nm (blue) and 540 nm (green). In NBI mode, light is absorbed strongly by haemoglobin and penetrates only the superficial layers of tissue, increasing the visibility of capillaries and superficial tissue structures. Since its introduction in endoscopic systems, the use of NBI has spread rapidly. In the last five years, it has become the standard for the early recognition of Barrett’s oesophagus and has been successfully employed to distinguish benign from malignant colorectal polyps.2,3 Particularly NBI was able to improve the detection of flat cancerous lesions.4,5

What is the Difference from Photodynamic Diagnosis?

The examination of the bladder in NBI mode is aimed at increasing the detection of cancerous lesions of the bladder. Photodynamic diagnosis (PDD) has the same goal but is a completely different procedure. PDD exploits the physical phenomenon of fluorescence. It needs the instillation of a substance to be incorporated in the urothelial cells of the mucosa. PDD relies on the metabolism of the cell. The higher the metabolic activity, the stronger is the fluorescence that would be elicited after blue light stimulation. Cancer cells are thought to have a greater mitotic activity and as a consequence, to emanate more fluorescence than healthy cells. Therefore PDD is not an optical enhancement technology, but an in vivo ‘metabolic’ examination, and therefore it is theoretically superior to NBI in regard to the detection and treatment of non-muscle-invasive bladder cancer.

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