10 MARCH 2019 • HEALTHCARE INNOVATIONS


histopathological sampling as a means of diagnosis.


NARROW BAND IMAGING HAS MADE A BIG DIFFERENCE TO HOW I CAN MANAGE MY PATIENTS


to see with white light alone. Narrow Band Imaging helps me to find all the patient’s tumours more accurately and therefore treat them all first time. As a result, it may reduce the risk of local tumour recurrence within the bladder,


something that’s unfortu-


nately quite a frequent occurrence with this type of cancer. Another big advantage I find with


Narrow Band Imaging is that it helps me to analyse red patches in the bladder further and with more confi- dence. Suspicious red patches, indica- tive of early bladder cancer recurrence or a higher risk type of bladder cancer (known as carcinoma in situ), which can be difficult to see under white light, have characteristic appear- ances under Narrow Band Imaging. Other red patches that can be benign, changes or inflammation, have a different appearance under Narrow Band Imaging. As a result, I can decide which patients need to have a general anaesthetic biopsy and which don’t. Tis saves the patient a general anaesthetic,


an additional important to proce-


dure and a hospital visit. However, it’s


remember that Narrow Band Imaging doesn’t replace


ARE THERE ANY DOWNSIDES? DOES IT COST THE NHS MORE? None that I can think of. It comes as standard on current Olympus cystoscopes and has done for the last 13 years, additional costs.


so there aren’t any


IS THERE ANY SCIENTIFIC EVIDENCE TO BACK UP WHAT YOU’VE DISCOVERED? We reported our initial experience at St George’s Hospital, which showed a 16% increase in the number of patients found to have recurrent bladder cancer during surveillance and an 8% increase in the number of patients, not previously known to have bladder cancer, who were found to have bladder cancer for the first time after finding blood in their urine [1]. Others have reported similar find-


ings and a statistical analysis of combined data from many hospitals (meta-analysis) found an 18.6% higher detection rate of bladder cancers with Narrow Band Imaging, which resulted


in an additional 9.9% of patients being found to have bladder cancer. Tis was higher for carcinoma in situ with 31.1% more lesions identified and an additional 25.1% of patients being diagnosed with carcinoma in situ [2]. Tis study and others [3] have also shown a significantly lower local bladder cancer recurrence rate within the bladder following treat- ment where Narrow Band Imaging was used to visualise all the tumours.


DO ANY GUIDELINES RECOMMEND ITS USE? Current UK bladder cancer guidelines from the National Institute for Health and Care Excellence (NICE) recom- mend the use of one of either Narrow Band Imaging, Photodynamic Diag- nosis, urine cytology or a urinary biomarker test in addition to white light cystoscopy when operating on a suspected bladder cancer. In summary, Narrow Band Imaging


is a technology that enhances the image of the bladder during cystos- copy, resulting in better contrast and assessment of fine blood vessels. Tis, in turn, results in a greater detection of bladder cancers, with some studies reporting a subsequent reduction in local bladder tumour recurrences.


NARROW BAND IMAGING IS A TECHNOLOGY THAT ENHANCES THE IMAGE WE SEE WHEN DOING ENDOSCOPY


7


MR BEN AYRES, CONSULTANT UROLOGICAL SURGEON, ST GEORGE’S HOSPITAL


Olympus Medical, KeyMed House, Stock Road, Southend-on-Sea, Essex SS2 5QH


T: 01702 616333 olympus.co.uk


1. Lam W, Ayres B, Fernando A, Perry M. Narrow band imaging improves the detection of new and recurrent bladder cancers and carcinoma-in-situ. J Urol 2013; 189: e522


2. Xiong Y, Li J, Ma S, Ge J, Zhou L, Li D, Chen Q. A meta-analysis of narrow band imaging for the diagnosis and therapeutic outcome of non-muscle invasive bladder cancer. PLoS One 2017; 12: e0170819.


3. Lee JY, Cho KS, Kang DH, Jung HD, Kwon JK, Oh CK, Ham WS, Choi YD. A network meta-analysis of therapeutic outcomes after new image technology-assisted transurethral resection for non-muscle invasive bladder cancer: 5-aminolaevulinic acid fluorescence vs hexylaminolevulinate fluorescence vs narrow band imaging. BMC Cancer 2015; 15: 566.


are referred for cystoscopy for many reasons, such as blood in the urine, surveillance after a diagnosis of bladder cancer to check for recurrent tumours, difficulty passing urine and recurrent urine infections.


HOW LONG HAVE YOU BEEN USING IT? I’ve been using it at St George’s Hospital since January 2010.


WHAT BENEFITS HAVE YOU SEEN WITH YOUR PATIENTS? Narrow Band Imaging has made a big difference to how I can manage my patients. I specialise in bladder cancer and so most of the time I use it either in patients presenting with new bladder tumours, often after seeing blood in their urine, or for bladder cancer surveillance. Bladder tumours have an increased


blood supply and so enhance more with Narrow Band Imaging than other types of bladder lining changes. While larger bladder tumours are usually easy to see with standard white light cystoscopy, smaller ones and subtle satellite tumours that fan out from the main one can be harder


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