Rom J Morphol Embryol 2015, 56(3):1069–1076 ISSN (print) 1220–0522 ISSN (on-line) 2066–8279 ORIGINAL PAPER Carcinoma in situ of the urinary bladder – from pathology to narrow band imaging BOGDAN FLORIN GEAVLETE 1) , ALICE BRÎNZEA 2) , IONEL ALEXANDRU CHECHERIŢĂ 3) , SABINA ANDRADA ZURAC 4) , DRAGOŞ ADRIAN GEORGESCU 1) , ALEXANDRA EUGENIA BASTIAN 4) , COSMIN VICTOR ENE 1) , CĂTĂLIN ANDREI BULAI 1) , DANA-OLIVIANA GEAVLETE 5) , MAGDA RUXANDRA ZAHARIA 6) , PETRIŞOR AURELIAN GEAVLETE 1) 1) Department of Urology, “Sf. Ioan” Emergency Clinical Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2) Department Pathophysiology II, No. 2 Clinical Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 3) Department of Nephrology and Dialysis, “Sf. Ioan” Emergency Clinical Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 4) Department of Pathology, Colentina University Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 5) Department of Cardiology, “Prof. Dr. C. C. Iliescu” Institute of Emergency for Cardiovascular Diseases, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 6) Department of Internal Medicine, “Sf. Ioan” Emergency Clinical Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Abstract Objectives: A retrospective clinical analysis was performed over a time period of 10 months while aiming to establish the impact of narrow band imaging (NBI) cystoscopy and transurethral resection of bladder tumors (TURBT) in cases of carcinoma in situ (CIS). Materials and Methods: CIS tumor cells are characterized by a high cytological grade, a certain degree of cyto-nuclear pleomorphism, large, irregular, hyperchromatic nuclei, high nuclear/cytoplasmatic ratio and mitotic figures. One hundred thirty-nine patients were consecutively diagnosed with non-muscle invasive bladder cancer (NMIBC) based on standard white light cystoscopy (WLC) and NBI vision. Urinary cytology was performed in cases of flat lesions suspected by either type of cystoscopy before the TURBT staging. Conventional endoscopic resection was performed for all white light (WL) visible lesions and NBI-guided TURBT exclusively for the observed tumors. Results: At subsequent pathological analysis, 13 CIS patients were confirmed. NBI cystoscopy emphasized a superior diagnostic accuracy as compared to WLC concerning the cases’ (92.3% versus 69.2%) as well as lesions’ (93.75% versus 71.9%) detection rates. NBI-TURBT provided a higher proportion of additional tumors’ cases (53.8% versus 15.4%) when compared to classical resection but was marked by an increased frequency of false-positive results (18.9% versus 11.5%). Urinary cytology displayed an 84.6% sensitivity rate. Conclusions: NBI cystoscopy and resection substantially ameliorated the CIS-related diagnostic accuracy within a parallel to the standard endoscopic approach at the cost of a reduced specificity. NBI-TURBT was able to find more CIS patients as well as lesions, thus improving the sensitivity of standard resection and urinary cytology. Keywords: narrow band imaging, carcinoma in situ, white light cystoscopy, transurethral resection of bladder tumors.  Introduction Based on the present knowledge, carcinoma in situ (CIS) represents one of the most aggressive stages of non- muscle invasive bladder cancer (NMIBC) with high risk of recurrence and progression [1]. Therefore, an early and accurate diagnosis is mandatory, but unfortunately the standard white light cystoscopy (WLC) is not efficient enough to detect this type of malignancy [2, 3]. Considering these aspects and additionally increased prevalence, superior and advanced endoscopic diagnostic tools needed to be emphasized for the benefit of CIS patients regarding oncological targeted treatments and long-term survival, as well [3, 4]. As an alternative, several years ago, narrow band imaging (NBI) cystoscopy was introduced as a promising modality of ameliorating NMIBC diagnostic accuracy [4] and according to the literature, it can also remove left-a-side tumors by the classical transurethral resection of bladder tumors (TURBT) [5, 6]. Hypothetically speaking, the ability to highlight the specific vascular architecture of urothelial carcinomas proves NBI superiority over WLC in observing the relatively less evident flat CIS formations [7, 8]. Still, there are very few reports specifically targeting carcinoma in situ study groups and eventual diagnostic advantages of NBI visua- lization when compared to WLC [8]. Based on these premises, the present retrospective clinical analysis took into account a 10 months inclusion period. As far as the actual objectives of the study were concerned, it aimed to establish the eventual evidence based impact of the NBI diagnostic and therapeutic approach within a retrospective comparison to the consecrated standard WLC-TURBT management. R J M E Romanian Journal of Morphology & Embryology http://www.rjme.ro/