Objective  To investigate the diagnostic performance and patient compliance of narrow-band imaging (NBI) combined with electronic flexible cystoscopy in the follow-up of bladder cancer (BCa) patients after bladder-preserving therapy (BPT), and to provide evidence for optimizing follow-up strategies.

Methods  Clinical data of BCa patients who underwent BPT at the Harbin Medical University Cancer Hospital between January 2022 and June 2025 were retrospectively analyzed. An OLYMPUS electronic flexible cystoscope system was used to perform examinations under both white-light imaging (WLI) and NBI modes. Lesion detection rates and diagnostic performance were compared between the two imaging modalities. Patient comfort during examination was evaluated using the Visual Analog Scale (VAS), and follow-up compliance was also analyzed.

Results  A total of 268 BCa patients were included. A total of 808 lesions were detected, including 679 malignant lesions and 129 benign lesions. Compared with WLI, the NBI mode demonstrated significantly higher sensitivity (100.0% vs. 77.5%), accuracy (86.1% vs. 68.1%), and average number of detected lesions (2.95±0.85 vs. 2.35±1.60). The advantages of NBI were particularly evident for micro-lesions ≤0.5 cm (detection rate difference: 36.6%), early-stage tumors (Ta-T1, detection rate difference: 24.9%-27.5%), and low-grade lesions (detection rate difference: 29.6%). Comfort evaluation showed that 79.5% of patients had VAS scores of 0-3, indicating no significant discomfort. In terms of compliance, 65.7% of patients were willing to undergo the examination again. Spearman correlation analysis revealed a significant negative correlation between VAS score and compliance willingness with follow-up (r=-0.694, P<0.01).

Conclusion  NBI combined with electronic flexible cystoscopy demonstrates higher detection efficiency for malignant lesions during follow-up after BPT for BCa patients, while also providing good patient comfort and follow-up compliance, indicating excellent overall clinical value.

1. Lopez-Beltran A, Cookson MS, Guercio BJ, et al. Advances in diagnosis and treatment of bladder cancer[J]. BMJ, 2024, 384: e076743.

2. Zlotta AR, Ballas LK, Niemierko A, et al. Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis[J]. Lancet Oncol, 2023, 24(6): 669-681.

3. Fan X, He W, Huang J. Bladder-sparing approaches for muscle invasive bladder cancer: a narrative review of current evidence and future perspectives[J]. Transl Androl Urol, 2023, 12(5): 802-808.

4. Su X, Dong C, Liao W, et al. Oncological effectiveness of bladder-preserving trimodal therapy versus radical cystectomy for the treatment of muscle-invasive bladder cancer: a systematic review and Meta-analysis[J]. World J Surg Oncol, 2023, 21(1): 271.

5. Chang S, Wintergerst GA, Carlson C, et al. Low-cost and label-free blue light cystoscopy through digital staining of white light cystoscopy videos[J]. Commun Med (Lond), 2024, 4(1): 269.

6. Raskolnikov D, Brown B, Holt SK, et al. Reduction of pain during flexible cystoscopy: a systematic review and Meta-analysis[J]. J Urol, 2019, 202(6): 1136-1142.

7. 郭瑞, 张庆, 谢民, 等. 窄带成像内镜在寻找误诊口咽癌隐匿性原发病灶中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(2): 130-135. [Guo R, Zhang Q, Xie M, et al. The application of NBI endoscopy in finding concealed primary lesions of misdiagnosis of oropharyngeal cancer[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2022, 36(2): 130-135.]

8. Magers MJ, Lopez-Beltran A, Montironi R, et al. Staging of bladder cancer[J]. Histopathology, 2019, 74(1): 112-134.

9. Humphrey PA, Moch H, Cubilla AL, et al. The 2016 WHO classification of tumours of the urinary system and male genital organs-part B: prostate and bladder tumours[J]. Eur Urol, 2016, 70(1): 106-119.

10. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance[J]. Scand J Pain, 2016, 13: 67-75.

11. Arnold CR, Lindner AK, Schachtner G, et al. Vinorelbine in bladder-preserving multimodality treatment for muscle-invasive bladder cancer:a valid option for cisplatin-unfit patients?[J]. Strahlenther Onkol, 2022, 198(1): 25-32.

12. Singer G, Ramakrishnan VM, Rogel U, et al. The role of new technologies in the diagnosis and surveillance of non-muscle invasive bladder carcinoma: a prospective, double-blinded, monocentric study of the XPERT bladder cancer monitor and narrow band imaging cystoscopy[J]. Cancers (Basel), 2022, 14(3): 618.

13. Hagimoto H, Makita N, Mine Y, et al. Comparison between 5-aminolevulinic acid photodynamic diagnosis and narrow-band imaging for bladder cancer detection[J]. BMC Urol, 2021, 21(1): 180.

14. Wan W, Liu H, Zou J, et al. The optimization and application of photodynamic diagnosis and autofluorescence imaging in tumor diagnosis and guided surgery: current status and future prospects[J]. Front Oncol, 2024, 14: 1503404.

15. Tang S, Zhou Y, Ju M. Multimodal optical imaging with multiphoton microscopy and optical coherence tomography[J]. J Biophotonics, 2012, 5(5-6): 396-403.

16. Shen YJ, Zhu YP, Ye DW. Narrow-band imaging flexible cystoscopy in the detection of primary non-muscle invasive bladder cancer: a "second look" matters?[J]. Int Urol Nephrol, 2012, 44(2): 451-457.

17. Kapoor H, Gupta E, Sood A. Chronic pelvic ischemia: etiology, pathogenesis, clinical presentation and management[J]. Minerva Urol Nephrol, 2014, 66(2): 127-137.

18. Huang B, Zheng J, Yao Z, et al. Efficacy of intra-arterial chemotherapy combined with intravesical chemotherapy in T1G3 bladder cancer when compared with intravesical chemotherapy alone after bladder-sparing surgery: a retrospective study[J]. World J Urol, 2019, 37(5): 823-829.

19. Mulawkar PM, Sharma G, Tamhankar A, et al. Role of macroscopic image enhancement in diagnosis of non-muscle-invasive bladder cancer: an analytical review[J]. Front Surg, 2022, 9: 762027.