Oncology Imaging
Figure 3: Narrow-band Imaging Function of the New URF-Videoscope Flexible Uteroscope – Urothelial Tumour
Figure 6: Examples of Endoscopic Views A
B
Figure 4: Comparative View (Same Patient) A C C
D B D
E
A: Cystoscopy (optical lens); B: Blue light with Hexvix system; C: Cystoscopy (olympus video system, CCD sensor); D: Narrow-band imaging system.
Figure 5: Frog’s Eggs Effect AB C
D
E clearly visualise UUT-TCC and to identify the extended tumour limits. Comments
A: Frog’s eggs; B: Urothelial tumour with white-light ureterorenoscopy; C: Urothelial tumour with narrow-band imaging system ‘frog’s eggs effect’; D: Urothelial irritation due to JJ stent (white-light ureterorenoscopy); and E: Urothelial irritation due to JJ stent (narrow-band imaging system) with no ‘frog’s eggs effect’.
In five patients out of 13 (38.4%) newly-diagnosed with UUT-TCC, NBI provided additional diagnostic information. In these cases, the indications for conservative therapy were represented by moderate renal failure, single functioning kidney and small single tumours. In two patients (7.4%), a complete inspection of the pyelocaliceal system proved to be impossible due to the inaccessibility of the lower pole. There were 35 pathologically confirmed transitional cell tumours detected. NBI exclusively diagnosed five tumours (14.2%) and identified extended limits for another three tumours (8.5%). Therefore, tumour detection rate improves by 22.7% by using the NBI technique (see Figure 6).
34
UUT-TCC diagnosis has always represented a challenge in the urological field. Flexible ureteroscopy appeared to be a promising solution, allowing the urologist to perform a visual inspection of the entire renal collecting system. However, several technical problems exist, such as the poor quality of biopsies or endoscopic images.5–11
NBI brings a new perspective to the currently developing field of diagnostic flexible ureteroscopy.2–4
The digital images produced are
consistently more accurate and descriptive by comparison to standard images; moreover NBI mode enables detailed identification of the vascularisation of tumours. Specifically, optical image enhancement technology increases the visibility of capillaries and other delicate tissue surface structures by enhancing the contrast between them.
EUROPEAN UROLOGICAL REVIEW
A: Multiple lesions in pyelo-caliceal left kidney – aspect in white light (WL) and narrow-band imaging (NBI); B: Solitary lesion in front of the renal papilla – aspect in NBI and WL; C: Small lesion: more visible with NBI versus WL; D: Extent limits more precisely defined with NBI in comparison with WL; E: No tumour visible with WL; papillary tumour is clearly visible with NBI.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84