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Grobet-Jeandin E, Lenfant L, Pinar U, Parra J, Mozer P, Renard-Penna R, Thibault C, Rouprêt M, Seisen T. Management of patients with muscle-invasive bladder cancer with clinical evidence of pelvic lymph node metastases. Nat Rev Urol 2024; 21:339-356. [PMID: 38297079 DOI: 10.1038/s41585-023-00842-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/02/2024]
Abstract
Identification of clinically positive pelvic lymph node metastases (cN+) in patients with muscle-invasive bladder cancer is currently challenging, as the diagnostic accuracy of available imaging modalities is limited. Conventional CT is still considered the gold-standard approach to diagnose lymph node metastases in these patients. The development of innovative diagnostic methods including radiomics, artificial intelligence-based models and molecular biomarkers might offer new perspectives for the diagnosis of cN+ disease. With regard to the treatment of these patients, multimodal strategies are likely to provide the best oncological outcomes, especially using induction chemotherapy followed by radical cystectomy and pelvic lymph node dissection in responders to chemotherapy. Additionally, the use of adjuvant nivolumab has been shown to decrease the risk of recurrence in patients who still harbour ypT2-T4a and/or ypN+ disease after surgery. Alternatively, the use of avelumab maintenance therapy can be offered to patients with unresectable cN+ tumours who have at least stable disease after induction chemotherapy alone. Lastly, patients with cN+ tumours who are not responding to induction chemotherapy are potential candidates for receiving second-line treatment with pembrolizumab.
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Affiliation(s)
- Elisabeth Grobet-Jeandin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Louis Lenfant
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Jérôme Parra
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Pierre Mozer
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Raphaele Renard-Penna
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Radiology, 75013, Paris, France
| | - Constance Thibault
- Department of medical oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP centre, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Thomas Seisen
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France.
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Fávero Prietto Dos Santos J, Ghezzi CLA, Pedrollo IM, Cruz ÍR, Orozco OFG, Zapparoli M, Schuch A, Muglia VF. Practical Guide to VI-RADS: MRI Protocols, Lesion Characterization, and Pitfalls. Radiographics 2024; 44:e230149. [PMID: 38421912 DOI: 10.1148/rg.230149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Urothelial carcinoma is the most common type of bladder cancer (BC), accounting for approximately 90% of all cases. Evaluating the depth of tumor invasion in the bladder wall (tumor staging) is essential for determining the treatment and prognosis in patients with BC. Neoadjuvant therapy followed by radical cystectomy is the most common treatment of localized muscle-invasive BC (MIBC). Therefore, it is vital to differentiate non-MIBC from MIBC. Transurethral resection of bladder tumor (TURBT) is the reference standard to determine the extent of tumor invasion into the bladder wall through tissue sampling. However, this diagnostic and therapeutic method may not adequately sample the muscularis propria, leading to a higher risk of residual disease, early recurrence, and tumor understaging in approximately 50% of patients during the initial TURBT. Multiparametric MRI can overcome some of the limitations of TURBT when evaluating BC, particularly regarding tumor staging. In this context, the Vesical Imaging Reporting and Data System (VI-RADS) classification was developed to establish standards for bladder multiparametric MRI and interpretation. It uses a 5-point scale to assess the likelihood of detrusor muscle invasion. T2-weighted MR images are particularly useful as an initial guide, especially for categories 1-3, while the presence of muscular invasion is determined with diffusion-weighted and dynamic contrast-enhanced sequences. Diffusion-weighted imaging takes precedence as the dominant method when optimal image quality is achieved. The presence of a stalk or a thickened inner layer and no evidence of interruption of the signal intensity of the muscular layer are central for predicting a low likelihood of muscle invasion. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Hoegger in this issue.
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Affiliation(s)
- Jônatas Fávero Prietto Dos Santos
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Caroline Lorenzoni Almeida Ghezzi
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Ivan Morzoletto Pedrollo
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Ítalo Ribeiro Cruz
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Oscar Fernando Ghattas Orozco
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Maurício Zapparoli
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Alice Schuch
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Valdair Francisco Muglia
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
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Tandon M, Chakraborty S, Barkondaj B, Choudhury S, Pal DK. Role of multiparametric MRI in predicting muscle invasiveness in urinary bladder neoplasms with pathological correlations. Urologia 2024; 91:55-60. [PMID: 37886848 DOI: 10.1177/03915603231204078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Urinary bladder cancer (BC) is one of the most frequent malignancies and the ninth most common malignancy worldwide. The objective of this study is to assess the role of multiparametric magnetic resonance imaging (mp-MRI) in predicting the invasiveness of urinary bladder space occupying lesions. Thirty-five patients diagnosed with bladder masses underwent an mp-MRI study. The results of three image sets were analysed and compared with the histopathological results as a reference standard: T2-weighted image (T2WI) plus dynamic contrast-enhanced (DCE), T2WI plus diffusion-weighted images (DWI), and mp-MRI, including T2WI plus DWI and DCE. The diagnostic accuracy of mp-MRI was evaluated using receiver operating characteristic curve analysis. We discovered a highly significant correlation between muscle invasiveness as staged by HPE (Histopathological examination) and mp-MRI utilising a VI-RADS score >3 (p 0.001) with a sensitivity of 100% and a specificity of 85.7%. With a diagnostic accuracy of 77.14%, a sensitivity of 92.31%, a specificity of 72.72%, a positive predictive value of 66.67%, and a negative predictive value of 94.11%, In terms of muscle invasiveness, there is good concordance between HPE staging and mp-MRI utilising the VI-RADS score. The mean apparent diffusion coefficient (ADC) values were higher in low grades than in high grades. The ROC curve study revealed a very strong correlation between HPE grade and ADC (p = 0.045). In 77.14% of patients, Mp-MRI correctly identified the local T stage. Mp-MRI is imaging biomarker for invasiveness and grade of tumour. The tumours with high grade are more invasive. However, the diagnostic accuracy of mp-MRI in determining muscle invasiveness is not very high and it overstages the disease in some cases (33.3%). Its clinical usefulness in determining muscle invasiveness before TURBT and histopathological examination can be questioned.
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Affiliation(s)
- Mrinal Tandon
- Department of Urology, IPGME&R, Kolkata, West Bengal, India
| | | | | | - Sunirmal Choudhury
- Department of urology, Medical College Hospital, Kolkata, West Bengal, India
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Cai Q, Huang Y, Ling J, Kong L, Lin Y, Chen Y, Cao W, Liao Y, Guo Y, Guan J, Wang H. Radiomics nomogram for predicting disease-free survival after partial resection or radical cystectomy in patients with bladder cancer. Br J Radiol 2024; 97:201-209. [PMID: 38263836 PMCID: PMC11027261 DOI: 10.1093/bjr/tqad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/13/2023] [Accepted: 10/25/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To create a MRI-derived radiomics nomogram that combined clinicopathological factors and radiomics signature (Rad-score) for predicting disease-free survival (DFS) in patients with bladder cancer (BCa) following partial resection (PR) or radical cystectomy (RC), including lymphadenectomy (LAE). METHODS Finally, 80 patients with BCa after PR or RC with LAE were enrolled. Patients were randomly split into training (n = 56) and internal validation (n = 24) cohorts. Radiomic features were extracted from T2-weighted, dynamic contrast-enhanced, diffusion-weighted imaging, and apparent diffusion coefficient sequence. The least absolute shrinkage and selection operator (LASSO) Cox regression algorithm was applied to choose the valuable features and construct the Rad-score. The DFS prediction model was built using the Cox proportional hazards model. The relationship between the Rad-score and DFS was assessed using Kaplan-Meier analysis. A radiomics nomogram that combined the Rad-score and clinicopathological factors was created for individualized DFS estimation. RESULTS In both the training and validation cohorts, the Rad-score was positively correlated with DFS (P < .001). In the validation cohort, the radiomics nomogram combining the Rad-score, tumour pathologic stage (pT stage), and lymphovascular invasion (LVI) achieved better performance in DFS prediction (C-index, 0.807; 95% CI, 0.713-0.901) than either the clinicopathological (C-index, 0.654; 95% CI, 0.467-0.841) or Rad-score-only model (C-index, 0.770; 95% CI, 0.702-0.837). CONCLUSION The Rad-score was an independent predictor of DFS for patients with BCa after PR or RC with LAE, and the radiomics nomogram that combined the Rad-score, pT stage, and LVI achieved better performance in individual DFS prediction. ADVANCES IN KNOWLEDGE This study provided a non-invasive and simple method for personalized and accurate prediction of DFS in BCa patients after PR or RC.
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Affiliation(s)
- Qian Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yiping Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jian Ling
- Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510700, China
| | - Lingmin Kong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yingyu Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Wenxin Cao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yuting Liao
- Philips Healthcare, Guangzhou, Guangdong 510220, China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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Akin O, Lema-Dopico A, Paudyal R, Konar AS, Chenevert TL, Malyarenko D, Hadjiiski L, Al-Ahmadie H, Goh AC, Bochner B, Rosenberg J, Schwartz LH, Shukla-Dave A. Multiparametric MRI in Era of Artificial Intelligence for Bladder Cancer Therapies. Cancers (Basel) 2023; 15:5468. [PMID: 38001728 PMCID: PMC10670574 DOI: 10.3390/cancers15225468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
This review focuses on the principles, applications, and performance of mpMRI for bladder imaging. Quantitative imaging biomarkers (QIBs) derived from mpMRI are increasingly used in oncological applications, including tumor staging, prognosis, and assessment of treatment response. To standardize mpMRI acquisition and interpretation, an expert panel developed the Vesical Imaging-Reporting and Data System (VI-RADS). Many studies confirm the standardization and high degree of inter-reader agreement to discriminate muscle invasiveness in bladder cancer, supporting VI-RADS implementation in routine clinical practice. The standard MRI sequences for VI-RADS scoring are anatomical imaging, including T2w images, and physiological imaging with diffusion-weighted MRI (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI). Physiological QIBs derived from analysis of DW- and DCE-MRI data and radiomic image features extracted from mpMRI images play an important role in bladder cancer. The current development of AI tools for analyzing mpMRI data and their potential impact on bladder imaging are surveyed. AI architectures are often implemented based on convolutional neural networks (CNNs), focusing on narrow/specific tasks. The application of AI can substantially impact bladder imaging clinical workflows; for example, manual tumor segmentation, which demands high time commitment and has inter-reader variability, can be replaced by an autosegmentation tool. The use of mpMRI and AI is projected to drive the field toward the personalized management of bladder cancer patients.
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Affiliation(s)
- Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alfonso Lema-Dopico
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
| | - Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
| | | | | | - Dariya Malyarenko
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alvin C. Goh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Bernard Bochner
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jonathan Rosenberg
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lawrence H. Schwartz
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
| | - Amita Shukla-Dave
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
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De Hertogh O. [Bladder preservation treatments for bladder cancer: Trimodality therapy, an overview of clinical practices in 2023]. Cancer Radiother 2023; 27:562-567. [PMID: 37481342 DOI: 10.1016/j.canrad.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/24/2023]
Abstract
Bladder cancer is the most frequent tumor of the urinary tract. Patients diagnosed at a stage when the tumor has spread into or through the muscle layer of the bladder wall are usually treated with cystectomy. The evolution of cancer treatments, related to the development of alternative treatment options to the historical surgical standard and to the implication of the patient as an actor in decision-making, trends towards organ and function preservation without sacrificing efficacy. Trimodality therapy, which is a maximal transurethral resection of the tumor followed by concurrent chemoradiation, is an interesting therapeutic alternative for patients unfit for surgery and for those wishing to benefit from organ preservation. Radiotherapy offers excellent treatment possibilities for muscle-invasive bladder cancer. In selected T2-stage patients fit for trimodality therapy, it has an equivalent oncological outcome compared to cystectomy while having less severe complications and offering organ preservation. It remains feasible in inoperable patients while offering significant perspectives of relapse-free survival. Finally, it also is an efficient palliative treatment in patients where mid-term local control and hemostasis are sought after.
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Affiliation(s)
- O De Hertogh
- Radiation oncology department, CHR Verviers East Belgium, 29, rue du Parc, 4800 Verviers, Belgique.
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Jiang X, Hu Z, Wang S, Zhang Y. Deep Learning for Medical Image-Based Cancer Diagnosis. Cancers (Basel) 2023; 15:3608. [PMID: 37509272 PMCID: PMC10377683 DOI: 10.3390/cancers15143608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: The application of deep learning technology to realize cancer diagnosis based on medical images is one of the research hotspots in the field of artificial intelligence and computer vision. Due to the rapid development of deep learning methods, cancer diagnosis requires very high accuracy and timeliness as well as the inherent particularity and complexity of medical imaging. A comprehensive review of relevant studies is necessary to help readers better understand the current research status and ideas. (2) Methods: Five radiological images, including X-ray, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission computed tomography (PET), and histopathological images, are reviewed in this paper. The basic architecture of deep learning and classical pretrained models are comprehensively reviewed. In particular, advanced neural networks emerging in recent years, including transfer learning, ensemble learning (EL), graph neural network, and vision transformer (ViT), are introduced. Five overfitting prevention methods are summarized: batch normalization, dropout, weight initialization, and data augmentation. The application of deep learning technology in medical image-based cancer analysis is sorted out. (3) Results: Deep learning has achieved great success in medical image-based cancer diagnosis, showing good results in image classification, image reconstruction, image detection, image segmentation, image registration, and image synthesis. However, the lack of high-quality labeled datasets limits the role of deep learning and faces challenges in rare cancer diagnosis, multi-modal image fusion, model explainability, and generalization. (4) Conclusions: There is a need for more public standard databases for cancer. The pre-training model based on deep neural networks has the potential to be improved, and special attention should be paid to the research of multimodal data fusion and supervised paradigm. Technologies such as ViT, ensemble learning, and few-shot learning will bring surprises to cancer diagnosis based on medical images.
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Grants
- RM32G0178B8 BBSRC
- MC_PC_17171 MRC, UK
- RP202G0230 Royal Society, UK
- AA/18/3/34220 BHF, UK
- RM60G0680 Hope Foundation for Cancer Research, UK
- P202PF11 GCRF, UK
- RP202G0289 Sino-UK Industrial Fund, UK
- P202ED10, P202RE969 LIAS, UK
- P202RE237 Data Science Enhancement Fund, UK
- 24NN201 Fight for Sight, UK
- OP202006 Sino-UK Education Fund, UK
- RM32G0178B8 BBSRC, UK
- 2023SJZD125 Major project of philosophy and social science research in colleges and universities in Jiangsu Province, China
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Affiliation(s)
- Xiaoyan Jiang
- School of Mathematics and Information Science, Nanjing Normal University of Special Education, Nanjing 210038, China; (X.J.); (Z.H.)
| | - Zuojin Hu
- School of Mathematics and Information Science, Nanjing Normal University of Special Education, Nanjing 210038, China; (X.J.); (Z.H.)
| | - Shuihua Wang
- School of Computing and Mathematical Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | - Yudong Zhang
- School of Computing and Mathematical Sciences, University of Leicester, Leicester LE1 7RH, UK;
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8
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Lai AL, Law YM. VI-RADS in bladder cancer: Overview, pearls and pitfalls. Eur J Radiol 2023; 160:110666. [PMID: 36689790 DOI: 10.1016/j.ejrad.2022.110666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) of the urinary bladder has shown high diagnostic performance in accurate staging of bladder cancer. Vesical Imaging Reporting and Data System (VI-RADS) scoring was developed in 2018 to standardize imaging and reporting of bladder cancer on mpMRI and is an excellent tool in preoperative T-staging of patients with high risk bladder cancer. However, there is no concise guide in the literature for practical use of VI-RADS in everyday clinical reporting. In this review, we describe our experience with mpMRI in pretreatment workup of bladder cancer, illustrate the imaging characteristics of VI-RADS categories 1 to 5 using case review, and discuss practical pearls and pitfalls in the use of mpMRI and VI-RADS in the hope of providing an accessible reference for radiologists in daily reporting.
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Affiliation(s)
- Anna Lois Lai
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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9
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Nanoparticle-Based Techniques for Bladder Cancer Imaging: A Review. Int J Mol Sci 2023; 24:ijms24043812. [PMID: 36835222 PMCID: PMC9965346 DOI: 10.3390/ijms24043812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Bladder cancer is very common in humans and is often characterized by recurrences, compromising the patient's quality of life with a substantial social and economic impact. Both the diagnosis and treatment of bladder cancer are problematic due to the exceptionally impermeable barrier formed by the urothelium lining the bladder; this hinders the penetration of molecules via intravesical instillation while making it difficult to precisely label the tumor tissue for surgical resection or pharmacologic treatment. Nanotechnology has been envisaged as an opportunity to improve both the diagnostic and therapeutic approaches for bladder cancer since the nanoconstructs can cross the urothelial barrier and may be functionalized for active targeting, loaded with therapeutic agents, and visualized by different imaging techniques. In this article, we offer a selection of recent experimental applications of nanoparticle-based imaging techniques, with the aim of providing an easy and rapid technical guide for the development of nanoconstructs to specifically detect bladder cancer cells. Most of these applications are based on the well-established fluorescence imaging and magnetic resonance imaging currently used in the medical field and gave positive results on bladder cancer models in vivo, thus opening promising perspectives for the translation of preclinical results to the clinical practice.
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Huele EH, Veenboer PW, Wessels FJ, Jonges TN, Meijer RP. Value of multiparametric magnetic resonance imaging for local staging of invasive urinary bladder tumours. Urol Oncol 2023; 41:49.e7-49.e12. [PMID: 36441069 DOI: 10.1016/j.urolonc.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Initial tumour staging in bladder cancer mainly relies on the histo-pathological outcome of the transurethral bladder tumour resection (TURBT) and imaging by means of a CT-scan (CT-intravenous urography; CT-IVU). The reported risk of understaging varies from 24-50%. To further improve the the evaluation of depth of invasion of the bladder tumour the application of magnetic resonance imaging (MRI) may be useful. To substantiate the additional value of this imaging modality the present observational study was designed. STUDY DESIGN This is a prospective observational study to analyse bladder tumour staging with multiparametric magnetic resonance imaging (mpMRI) in patients with a known bladder tumour, who are planned for radical cystectomy. STUDY POPULATION Patients with an invasive bladder cancer who are planned for radical cystectomy. INTERVENTION Patients were accrued during their visit to the outpatient department of urology. They underwent routine cystoscopy, laboratory tests (including serum Creatinin) and CT-IVU investigations and subsequently a mpMRI. MAIN STUDY PARAMETERS/ENDPOINTS To demonstrate the value of mpMRI in the initial staging of bladder tumours using radiological bladder tumour stage (T-stage) based on mpMRI and pathological bladder tumour stage based on 'whole-mount' histo-pathology after radical cystectomy. RESULTS Thirty-seven participants with known bladder tumours underwent mpMRI and subsequent cystectomy. After mpMRI 10 participants were diagnosed with non-muscle-invasive bladder cancer (NMIBC) and 27 participants with muscle-invasive bladder cancer (MIBC). In the 'whole-mount' pathology results 12 participants had NMIBC and 25 participants had MIBC. We found a sensitivity and specificity of 0.88 en 0.58 respectively, for the evaluation of MIBC. The positive and negative predictive value were 81% and 70% respectively. The diagnostic accuracy of mpMRI to differentiate between NMIBC and MIBC was 78%. CONCLUSIONS We found a sensitivity of 88% and a specificity of 58% for mpMRI to discriminate NMIBC from MIBC.
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Affiliation(s)
- Eline H Huele
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands
| | - Paul W Veenboer
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands
| | - Frank J Wessels
- Department Radiology, University Medical Center Utrecht, The Netherlands
| | - Trudy N Jonges
- Department Pathology, University Medical Center Utrecht, The Netherlands
| | - Richard P Meijer
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands.
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11
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Messina E, Pecoraro M, Pisciotti ML, Del Giudice F, Lucciola S, Bicchetti M, Laschena L, Roberto M, De Berardinis E, Franco G, Panebianco V. Seeing is Believing: State of the Art Imaging of Bladder Cancer. Semin Radiat Oncol 2023; 33:12-20. [PMID: 36517189 DOI: 10.1016/j.semradonc.2022.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Imaging plays an important role in bladder cancer (BCa) diagnostic work-up. Ultrasound achieves an intermediate sensitivity in detecting urinary tract alterations and is considered a suboptimal imaging technique in diagnosis of BCa. CT urography accurately detects BCa in patients presenting with hematuria Multiparametric MRI achieves a very high rate of BCa detection and helps with accurate staging of patients; however, this modality is still not widely supported by international guidelines. The main applications of MRI are local tumor staging and differentiation between non-muscle-invasive BCa and muscle-invasive BCa. These applications led to development of Vesical Imaging-Reporting and Data System (VI-RADS) scoring system. The VI-RADS scoring system was developed in the setting of post-resection of primary bladder tumor and instillation of intravesical Bacillus Calmette-Guerin therapy; however validation of this system in the post-treatment setting showed promising results. The high risk of BCa recurrence leads to its application in the assessment of response to therapy and for disease surveillance after treatment. MRI is rapidly becoming a leading imaging modality in BCa diagnostic workup, assessment of response to therapies and for longitudinal surveillance, and plays an important role in BCa surgical and radiation therapy treatment planning.
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Affiliation(s)
- Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Martina Lucia Pisciotti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Italy
| | - Sara Lucciola
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Marco Bicchetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Ludovica Laschena
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Michela Roberto
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Italy
| | - Giorgio Franco
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy..
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Yang X, Yuan B, Zhang Y, Zhuang J, Cai L, Wu Q, Cao Q, Li P, Lu Q, Sun X. Quantitative Multiparametric MRI as a Promising Tool for the Assessment of Early Response to Neoadjuvant Chemotherapy in Bladder Cancer. Eur J Radiol 2022; 157:110587. [DOI: 10.1016/j.ejrad.2022.110587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
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13
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The use of MRI in urothelial carcinoma. Curr Opin Urol 2022; 32:536-544. [DOI: 10.1097/mou.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Dong Q, Huang D, Xu X, Li Z, Liu Y, Lu H, Liu Y. Content and shape attention network for bladder wall and cancer segmentation in MRIs. Comput Biol Med 2022; 148:105809. [DOI: 10.1016/j.compbiomed.2022.105809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
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15
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Nicola R, Pecoraro M, Lucciola S, Dos Reis RB, Narumi Y, Panebianco V, Muglia VF. VI-RADS score system - A primer for urologists. Int Braz J Urol 2022; 48:609-622. [PMID: 35195385 PMCID: PMC9306377 DOI: 10.1590/s1677-5538.ibju.2021.0560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
Bladder cancer (BCa) is one of the most common cancers worldwide and is also considered to be one of the most relapsing and aggressive neoplasms. About 30% of patients will present with muscle invasive disease, which is associated with a higher risk for metastatic disease. The aim of this article is to review the state of art imaging in Radiology, while providing a complete guide to urologists, with case examples, for the rationale of the development of the Vesical Imaging Reporting and Data System (VI-RADS), a scoring system emphasizing a standardized approach to multiparametric Magnetic Resonance Imaging (mpMRI) acquisition, interpretation, and reporting for BCa. Also, we examine relevant external validation studies and the consolidated literature of mpMRI for bladder cancer. In addition, this article discusses some of the potential clinical implications of this scoring system for disease management and follow-up.
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Affiliation(s)
- Refky Nicola
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Sara Lucciola
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Rodolfo Borges Dos Reis
- Departamento de Cirurgia, Divisão de Urologia - Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil
| | | | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Valdair Francisco Muglia
- Departamento de Imagens Médicas, Oncologia e Hematologia - Divisão de Imagem, Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil
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16
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Cai Q, Ling J, Kong L, Huang Y, Lin Y, Wen Z, Li M, Guo Y, Wang H. Multiparametric MRI Evaluation of VI-RADS for Bladder Tumors Located at the Ureteral Orifice. Radiology 2022; 304:593-599. [PMID: 35670714 DOI: 10.1148/radiol.220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The Vesical Imaging Reporting and Data System (VI-RADS) based on multiparametric MRI scans standardizes preoperative bladder cancer staging. However, limitations have been reported for VI-RADS, particularly for ureteral orifice tumors. Purpose To investigate the diagnostic performance and interobserver agreement of VI-RADS in evaluating muscle invasion for bladder tumors located at the ureteral orifice. Materials and Methods In this retrospective study, patients with histopathologically confirmed bladder cancer occurring at the ureteral orifice from January 2012 to November 2021 were analyzed. Two blinded radiologists independently scored multiparametric MRI scans according to VI-RADS. Interobserver agreement of the VI-RADS scores was evaluated with weighted κ analysis. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance of the VI-RADS scores in the prediction of muscle invasion. Results A total of 78 patients (mean age, 67 years ± 7 [SD]; age range, 46-90 years; 67 men) were included in the final analysis: 25 with non-muscle-invasive bladder cancer and 53 with muscle-invasive bladder cancer (MIBCa). At consensus reading, one (1%) case was scored as VI-RADS 1, 27 cases (35%) were scored as VI-RADS 2, six (8%) were scored as VI-RADS 3, 10 (13%) were scored as VI-RADS 4, and 34 (44%) were scored as VI-RADS 5. On comparison of the VI-RADS score with histopathologic findings, it was confirmed that the presence of muscle invasion was 0% (zero of one) for VI-RADS 1, 15% (four of 27) for VI-RADS 2, 83% (five of six) for VI-RADS 3, 100% (10 of 10) for VI-RADS 4, and 100% (34 of 34) for VI-RADS 5. The area under the receiver operating characteristic curve of VI-RADS in the detection of MIBCa was 0.96 (95% CI: 0.92, 1.00). Conclusion The Vesical Imaging Reporting and Data System could be used to accurately predict muscle invasion for bladder tumors occurring at the ureteral orifice. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Qian Cai
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
| | - Jian Ling
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
| | - Lingmin Kong
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
| | - Yiping Huang
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
| | - Yingyu Lin
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
| | - Zhihua Wen
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
| | - Meiqin Li
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
| | - Yan Guo
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
| | - Huanjun Wang
- From the Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, PR China (Q.C., L.K., Y.H., Y.L., Z.W., M.L., Y.G., H.W.); and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China (J.L.)
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Elshetry ASF, El-fawakry RM, Hamed EM, Metwally MI, Zaid NA. Diagnostic accuracy and discriminative power of biparametric versus multiparametric MRI in predicting muscle-invasive bladder cancer. Eur J Radiol 2022; 151:110282. [DOI: 10.1016/j.ejrad.2022.110282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/03/2022]
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Ye L, Chen Y, Xu H, Xie H, Yao J, Liu J, Song B. Biparametric magnetic resonance imaging assessment for detection of muscle-invasive bladder cancer: a systematic review and meta-analysis. Eur Radiol 2022; 32:6480-6492. [PMID: 35362750 DOI: 10.1007/s00330-022-08696-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate if removing DCE from the Vesical Imaging Reporting and Data System (VI-RADS) influences the diagnostic accuracy of muscle-invasive bladder cancer (MIBC). We also explored using different reference standards on the MRI diagnostic performance. METHODS We searched the Cochrane Library, Embase, and PubMed databases to June 26, 2021. Pooled biparametric MRI (bpMRI, T2WI+DWI) and multiparametric MRI (mpMRI, T2WI+DWI+DCE) sensitivities and specificities and the diagnostic performances of these methods for MIBC were compared using different reference standards. RESULTS Seventeen studies with 2344 patients were finally included, of which 7 studies, including 1041 patients, reported the diagnostic performance of bpMRI. VI-RADS showed sensitivities and specificities of 0.91 (95% CI 0.87-0.94) and 0.86 (95% CI 0.77-0.91) at cutoff scores of 3, and 0.85 (95% CI 0.77-0.90) and 0.93 (95% CI 0.89-0.96) at cutoff scores of 4. BpMRI showed sensitivities and specificities of 0.90 (95% CI 0.69-0.97) and 0.90 (95% CI 0.81-0.95), and 0.84 (95% CI 0.78-0.88) and 0.97 (95% CI 0.87-0.99), respectively, for cutoff scores of 3 and 4. The sensitivities of bpMRI vs mpMRI for MIBC were not significantly different, but bpMRI was more specific than mpMRI at cutoff scores of 3 (p = 0.02) and 4 (p = 0.02). The VI-RADS studies using primary transurethral resection of bladder tumors (TURBT) as the reference standard had significantly higher sensitivities (p < 0.001) than those using secondary TURBT or radical cystectomy as the reference. DATA CONCLUSION BpMRI and conventional VI-RADS had similar diagnostic efficacies for MIBC. Since MRI overestimated MIBC diagnoses using primary TURBT as the reference standard, we recommend using secondary TURBT as the reference standard. KEY POINTS • Biparametric MRI without DCE had similar diagnostic efficacies for MIBC compared with conventional VI-RADS. • The sensitivity of VI-RADS was overestimated when referring to the primary TURBT results. • Biparametric MRI comprised of T2WI and DWI could be used for detecting MIBC in clinical practice.
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Affiliation(s)
- Lei Ye
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
| | - Yuntian Chen
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
| | - Hui Xu
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
| | - Huimin Xie
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
| | - Jin Yao
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China.
| | - Jiaming Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China.
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
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Coskun N, Cagdas B, Eroglu U, Aslan Y, Turkolmez S. The impact of 18F-fluorodeoxyglucose PET/computed tomography on clinical staging in bladder cancer. Nucl Med Commun 2022; 43:172-176. [PMID: 34783718 DOI: 10.1097/mnm.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To determine the impact of 18F-FDG PET/computed tomography (CT) on clinical staging in bladder cancer with comparison to conventional CT and MRI. METHODS A total of 142 patients who underwent 18F-FDG PET/CT imaging with a diagnosis of bladder cancer between 1 June 2019 and 31 December 2020 were screened retrospectively. Seventy patients who underwent diagnostic CT or MRI within 2 months before or after PET/CT were included in the study. The N and M stages determined by CT, MRI and PET/CT according to the eighth version of the TNM staging system were recorded. T-test was used to determine the levels of significant difference, and univariate logistic regression analysis was used to evaluate the impact of the T stage on nodal up-staging. RESULTS According to the PET/CT, the N stage increased in 19 patients (27.14%) and decreased in seven patients (10%). Likewise, the M stage increased in 16 patients (22.86%) and decreased in seven patients (10%). The N stage determined by PET/CT was confirmed by pathologic examination in all cases in which the two modalities were inconsistent. In muscle-invasive cases, the rate of increase in the N stage after PET/CT (36.95%) was found to be significantly higher than in that of cases without invasion (8.33%) (P = 0.011). Increasing T stage was associated with an increase in the N stage after PET/CT (odds ratio: 2.33, 95% confidence interval: 1.02-5.28, P = 0.042). CONCLUSION 18F-FDG PET/CT can potentially change the clinical stage determined by CT and MRI when used for staging in bladder cancer, and can lead to nodal up-staging particularly in cases with muscle-invasive bladder cancer.
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Affiliation(s)
| | | | | | - Yilmaz Aslan
- Department of Urology, Faculty of Medicine, University of Health Sciences
| | - Seyda Turkolmez
- Department of Nuclear Medicine, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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Settein MM, Sobh DM, Eteba SM, El-Diasty TA, Abouelkheir RT. Comparison between conventional and diffusion-weighted magnetic resonance imaging in predicting grade and stage of urinary bladder cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00365-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urinary bladder cancer is the second most common neoplasm of the urinary tract. Tumor staging and regional disease spread are the strongest predictors of treatment outcome. Our study aims to compare the diagnostic performance of conventional and diffusion-weighted magnetic resonance imaging (DW-MRI), using a 3T MR scanner, in grading and staging of urinary bladder cancer with histopathologic correlation.
Results
The sensitivity, specificity, and accuracy of combined use of HR T2WI and DWI were better than using HR T2WI only to differentiate T1 stage from further stages (95%, 100%, and 98%, respectively). Differentiating organ confined bladder cancer (T1 and T2 stages) from tumors with extravesical extension was better when using both HR T2WI and DWI than using HR T2WI (accuracy 100% and 93%, respectively). Kappa agreement was better when using both HR T2WI and DWI than HR T2WI only (0.963 and 0.496 respectively). Grade III lesions showed statistically significant lower ADC values than grades I and II with ADC cut off value ≤ 0.95 × 10−3 mm2/s. No statistically significant difference was found in ADC values between transitional cell carcinoma (TSC) and other cell types.
Conclusion
Combined use of DWI and HR T2WI provides more accurate urinary bladder cancer staging and prediction of aggressiveness of certain histologic grade (GIII lesions) using ADC values. 3 T scanners have the potential to achieve higher diagnostic capability in evaluation of urinary bladder cancer.
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21
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Erkoc M, Otunctemur A, Bozkurt M, Can O, Atalay HA, Besiroglu H, Danis E, Degirmentepe RB. The efficacy and reliability of VI-RADS in determining candidates for repeated transurethral resection in patients with high-risk non-muscle invasive bladder cancer. Int J Clin Pract 2021; 75:e14584. [PMID: 34185372 DOI: 10.1111/ijcp.14584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Our study aims to evaluate the efficiency and reliability of Vesical Imaging Reporting Data System (VI-RADS) in prospectively identifying the patients to undergo RE-TURBT in the management of patients with high-risk non-muscle invasive Bladder Cancer(HR-NMIBC).The secondary objective was to evaluate the performance of the VI-RADS scoring system in differentiating between muscle-invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer(NMIBC) prospectively. METHODS The study included 330 patients who underwent transurethral resection of bladder tumour(TURBT) for Bladder Cancer (BC) in our clinic. All patients underwent multiparametric-magnetic resonance imaging (Mp-MRI) before the operation and VI-RADS scoring was administered. The cut-off value of VI-RADS was accepted as three and above. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the differentiation between NMIBC and MIBC distinction in all patients. Receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the VI-RADS scoring system. In the second phase of the study, patients with MIBC and low-risk NMIBC (LR-NMBIC) were excluded and 158 patients with HR-NMIBC were included, and their sensitivity, specificity, PPV and NPV values were measured. ROC analysis was performed. RESULTS In all patients, sensitivity, specificity, PPV and NPV values of the VI-RADS scoring in the differentiation of MIBC and NMIBC were 91.3, 91.8, 81.7 and 96.3 respectively. The AUC value was 0.934 (95%CI: 0.903-0.964). Sensitivity, specificity, PPV and NPV values were found to be 87, 91.8, 74.1, 95.2 in the evaluation specifically made for patients with HR-NMIBC. The AUC value was 0.900 (95% CI:0.843-0.957). Inter-reader agreement was excellent (Ƙ = 0.90, 95% CI:0.71-0.95). CONCLUSIONS The VI-RADS scoring system is an effective and reliable method in determining the patients who will undergo RE-TURBT and in differentiating MIBC and NMIBC.
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Affiliation(s)
- Mustafa Erkoc
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Alper Otunctemur
- Department of Urology, Prof. Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Muammer Bozkurt
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Osman Can
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | | | - Huseyin Besiroglu
- Department of Urology, Istanbul-Cerrahpasa University Faculty of Medicine, Istanbul, Turkey
| | - Eyyup Danis
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Vesical Imaging Reporting and Data System (VI-RADS): Are the individual MRI sequences equivalent in diagnostic performance of high grade NMIBC and MIBC? Eur J Radiol 2021; 142:109829. [PMID: 34252867 DOI: 10.1016/j.ejrad.2021.109829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the diagnostic performance of the overall Vesical Imaging Reporting and Data System (VI-RADS) score and its individual magnetic resonance imaging (MRI) parameters in assessing grade and muscle invasiveness of bladder cancer (BC). METHODS This IRB-approved retrospective, single-center, cross-sectional study included patients with BC wo underwent 3 Tesla preoperative multiparametric (mp)-MRI including T2-weighted (T2w), diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE) sequences. An independent evaluation according to VI-RADS was performed by two radiologists in separate sessions, blinded to histological findings. RESULTS The mean age of 59 included patients was 68.2 (±13.6 standard deviation) years. Among bladder cancer patients, 26 (51%) were identified as high grade and 14 (27.5%) as muscle invasive urothelial carcinomas in histological sections. The area under the curve (AUC) for the overall VI-RADS score to predict muscle invasion was 0.986 (R1) and 0.992 (R2). The AUC to diagnose high grade bladder cancer was 0.908 (R1) and 0.905 (R2). There was no significance difference between the AUC of single parameters (T2w, DWI and DCE) compared to the total VI-RADS score (P > 0.05, respectively). Upon multivariate logistic regression, only the T2w VI-RADS score contributed independently to the diagnosis of high grade and muscle invasive bladder cancer (P = 0.001 (R1) and P = 0.0022 (R2) for high grade cancer; P = 0.0007 (R1) and P = 0.0019 (R2) for muscle invasiveness). CONCLUSION VI-RADS provides high diagnostic accuracy to diagnose high grade and muscle invasive BC. Our results suggest, that mp-MRI parameters provide overlapping information and for sake of clinical simplicity, a biparametric, contrast free image acquisition may be approached without sacrificing diagnostic accuracy.
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Iqbal U, Elsayed AS, Jing Z, Stoeckle M, Wijburg C, Wiklund P, Hosseini A, Dasgupta P, Khan MS, Hemal A, Kim EH, Wagner AA, Gaboardi F, Rha KH, Maatman T, Balbay D, Li Q, Hussein A, Guru KA. Upstaging and Survival Outcomes for Non-Muscle Invasive Bladder Cancer After Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. J Endourol 2021; 35:1541-1547. [PMID: 34139890 DOI: 10.1089/end.2021.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We sought to describe the incidence, risk factors, and survival outcomes associated with pathological upstaging from non-muscle invasive bladder cancer (NMIBC) to muscle invasive bladder cancer (MIBC) after robot-assisted radical cystectomy (RARC). METHODS We reviewed the International Robotic Cystectomy Consortium database between 2004 and 2020. Upstaging was defined as ≥pT2 or pN+ at final pathology from clinical <T2N0M0. Descriptive statistics were used to summarize data. Cochran-Armitage test was used to depict upstaging trend over time. Multivariate regression models were used to depict variables associated with upstaging. Kaplan Meier curves were used to describe disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). RESULTS 463 patients underwent RARC for NMIBC. Upstaging occurred in 145 (31%) patients. Upstaged patients were older (70 vs 67 years, p <0.01), more likely to have American Society of Anesthesiologists score (≥3) (55% vs 44%, p=0.04) and had higher rate of preoperative hydronephrosis (26% vs 10%, p <0.01). They were more likely to have positive surgical margins (10% vs 3%, p= 0.01), recurrences (28% vs 9%, p<0.01), and to receive adjuvant/salvage treatment (26% vs none, p <0.01). On multivariate analysis, upstaging was associated with older age (OR 1.04; CI 1.01-1.07, p<0.01), cT1 vs cTis (OR 4.25; CI 1.57-11.48, p <0.01), cT1 vs cTa (OR 2.92; CI 1.40-6.06, p<0.01), and preoperative hydronephrosis (OR 3.18; CI 1.60-6.32, p<0.01). Upstaged patients had worse 5-year RFS (53 % vs 85%, log rank p<0.01), DSS (66% vs 93%, log rank p<0.01), and OS (49% vs 74%, log rank p<0.01). The rate of upstaging did not significantly change over time (38% in 2004 to 27% in 2019, p=0.17). CONCLUSION Upstaging to MIBC occurred in a significant proportion of patients after RARC for NMIBC and was associated with worse survival outcomes. Older patients, those with cT1 disease and hydronephrosis were more likely to upstage.
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Affiliation(s)
- Umar Iqbal
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | - Ahmed S Elsayed
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States.,Cairo University Kasr Alainy Faculty of Medicine, 63527, Cairo, United States;
| | - Zhe Jing
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | - Michael Stoeckle
- Universitat des Saarlandes, 9379, Urologie, Saarbrucken, Germany;
| | | | | | - Abolfazl Hosseini
- Karolinska Institutet, Urology, 171 76 Stockholm, Stockholm, Sweden, 171 76 Stockhol;
| | - Prokar Dasgupta
- King's College London, 4616, MRC Centre for Transplantation, Guy's Hospital, London, United Kingdom of Great Britain and Northern Ireland, SE19RT.,Guy's and St Thomas' NHS Trust, Department of Urology, Guy's Hospital, London, United Kingdom of Great Britain and Northern Ireland, SE19RT;
| | | | - Ashok Hemal
- Wake Foresty University Baptist Medical Center, Urology, Medical Center Blvd, Winston-Salem, North Carolina, United States, 27157.,United States;
| | - Eric H Kim
- Washington University School of Medicine, Urology, 4960 Children's Place, Box 8242, St. Louis, Missouri, United States, 63110;
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center and Harvard Medical School, Urology, 330 Brookline Ave., Boston, Massachusetts, United States, 02215;
| | | | - Koon Ho Rha
- Severance Hospital, Yonsei University, Urology, Yonseiro 50-1, Seodaemun-gu, Seoul, Korea, Seoul, Korea (the Republic of);
| | - Thomas Maatman
- Metro Health: University of Michigan Health, Urological Surgery, Wyoming, Michigan, United States;
| | | | - Qiang Li
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | | | - Khurshid A Guru
- Roswell Park Cancer Insitute, Urologic Oncology, Elm and Carlton Streets, Buffalo, New York, United States, 14263.,Roswell Park Cancer Institute, Urologic Oncology, Elm and Carlton Streets, Buffalo, United States, 14263;
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Wang X, Tu N, Sun F, Wen Z, Lan X, Lei Y, Cui E, Lin F. Detecting Muscle Invasion of Bladder Cancer Using a Proposed Magnetic Resonance Imaging Strategy. J Magn Reson Imaging 2021; 54:1212-1221. [PMID: 33998725 DOI: 10.1002/jmri.27676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Accurate evaluation of the invasion depth of tumors with a Vesical Imaging-Reporting and Data System (VI-RADS) score of 3 is difficult. PURPOSE To evaluate the diagnostic performance of a new magnetic resonance imaging (MRI) strategy based on the integration of the VI-RADS and tumor contact length (TCL) for the diagnosis of muscle-invasive bladder cancer (MIBC). STUDY TYPE Single center, retrospective. SUBJECTS A group of 179 patients with a mean age of 67 years (range, 24.0-96.0) underwent multiparametric MRI (mpMRI) before surgery, including 147 (82.1%) males and 32 (17.9%) females. Twenty-four (13.4%), 90 (50.3%), 43 (24.0%), 15 (8.4%), and 7 (3.9%) cases were Ta, T1, T2, T3, and T4, respectively. FIELD STRENGTH/SEQUENCE A 1.5 T and 3.0 T, T2-weighted turbo spin-echo (TSE), single-shot echo-planar (SS-EPI), diffusion-weighted imaging (DWI), and T1-weighted volumetric interpolated breath-hold examination (T1-VIBE). ASSESSMENT Three radiologists independently graded the VI-RADS score and measured the TCL on index lesion images. A proposed MRI strategy called VI-RADS_TCL was introduced by modifying the VI-RADS score, which was downgraded to VI-RADS 3F (equal to a VI-RADS score of 2) if VI-RADS = 3 and TCL < 3 cm. STATISTICAL TESTS Intraclass correlation coefficients (ICCs), Mann-Whitney U test, chi-square tests, receiver operating characteristic (ROC) curves, and 2 × 2 contingency tables were applied. RESULTS Inter-reader agreement values were 0.941 (95% CI, 0.924-0.955) and 0.934 (95% CI, 0.916-0.948) for the TCL and VI-RADS score. The TCL was significantly increased in the MIBC group (6.40-6.85 cm) compared with the NMIBC group (1.98-2.45 cm) (P < 0.05). The specificity and positive predictive values (PPV) of VI-RADS_TCL were 82.46%-87.72% and 90.91%-91.59%, which were significantly greater than VI-RADS score (P < 0.05). Additionally, 52.17%-55.88% NMIBC lesions with VI-RADS 3 were downgraded to 3F by using VI-RADS_TCL. DATA CONCLUSION The proposed MRI strategy could reduce the false-positive rate of lesions with a VI-RADS score of 3 while retaining sensitivity. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Xiangyu Wang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Ning Tu
- PET-CT/MRI Center & Molecular Imaging Center, Wuhan University Renmin Hospital, Wuhan, 430060, China
| | - Feng Sun
- Department of Radiology, Shijiazhuang General Hospital, Shijiazhuang, 050000, China
| | - Zhi Wen
- Department of Radiology, Wuhan University Renmin Hospital, Wuhan, 430060, China
| | - Xinxin Lan
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Enming Cui
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun YAT-SEN University, Jiangmen, 529030, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China
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VI-RADS: Multiinstitutional Multireader Diagnostic Accuracy and Interobserver Agreement Study. AJR Am J Roentgenol 2021; 216:1257-1266. [DOI: 10.2214/ajr.20.23604] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Abouelkheir RT, Abdelhamid A, Abou El-Ghar M, El-Diasty T. Imaging of Bladder Cancer: Standard Applications and Future Trends. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57030220. [PMID: 33804350 PMCID: PMC8000909 DOI: 10.3390/medicina57030220] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
The evolution in imaging has had an increasing role in the diagnosis, staging and follow up of bladder cancer. Conventional cystoscopy is crucial in the diagnosis of bladder cancer. However, a cystoscopic procedure cannot always depict carcinoma in situ (CIS) or differentiate benign from malignant tumors prior to biopsy. This review will discuss the standard application, novel imaging modalities and their additive role in patients with bladder cancer. Staging can be performed with CT, but distinguishing between T1 and T2 BCa (bladder cancer) cannot be assessed. MRI can distinguish muscle-invasive from non-muscle-invasive tumors with accurate local staging. Vesical Imaging-Reporting and Data System (VI-RADS) score is a new diagnostic modality used for the prediction of tumor aggressiveness and therapeutic response. Bone scintigraphy is recommended in patients with muscle-invasive BCa with suspected bony metastases. CT shows low sensitivity for nodal staging; however, PET (Positron Emission Tomography)/CT is superior and highly recommended for restaging and determining therapeutic effect. PET/MRI is a new imaging technique in bladder cancer imaging and its role is promising. Texture analysis has shown significant steps in discriminating low-grade from high-grade bladder cancer. Radiomics could be a reliable method for quantitative assessment of the muscle invasion of bladder cancer.
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27
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Hijab A, Tocco B, Hanson I, Meijer H, Nyborg CJ, Bertelsen AS, Smeenk RJ, Smith G, Michalski J, Baumann BC, Hafeez S. MR-Guided Adaptive Radiotherapy for Bladder Cancer. Front Oncol 2021; 11:637591. [PMID: 33718230 PMCID: PMC7947660 DOI: 10.3389/fonc.2021.637591] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy has an important role in the curative and palliative treatment settings for bladder cancer. As a target for radiotherapy the bladder presents a number of technical challenges. These include poor tumor visualization and the variability in bladder size and position both between and during treatment delivery. Evidence favors the use of magnetic resonance imaging (MRI) as an important means of tumor visualization and local staging. The availability of hybrid systems incorporating both MRI scanning capabilities with the linear accelerator (MR-Linac) offers opportunity for in-room and real-time MRI scanning with ability of plan adaption at each fraction while the patient is on the treatment couch. This has a number of potential advantages for bladder cancer patients. In this article, we examine the technical challenges of bladder radiotherapy and explore how magnetic resonance (MR) guided radiotherapy (MRgRT) could be leveraged with the aim of improving bladder cancer patient outcomes. However, before routine clinical implementation robust evidence base to establish whether MRgRT translates into improved patient outcomes should be ascertained.
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Affiliation(s)
- Adham Hijab
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Boris Tocco
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ian Hanson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Hanneke Meijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Robert Jan Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gillian Smith
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Shaista Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Shi H, Zhang W, Bi X, Wang D, Xiao Z, Guan Y, Guan K, Tian J, Bai H, Hu L, Cao C, Jiang W, Hu Z, Zhang J, Chen Y, Zheng S, Feng X, Li C, Li Y, Ma J, Liu Y, Zhou A, Shou J. Neoadjuvant Chemotherapy-Guided Bladder-Sparing Treatment for Muscle-Invasive Bladder Cancer: Results of a Pilot Phase II Study. Cancer Res Treat 2021; 53:1156-1165. [PMID: 33592141 PMCID: PMC8524034 DOI: 10.4143/crt.2020.1356] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/09/2021] [Indexed: 01/31/2023] Open
Abstract
Purpose Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.
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Affiliation(s)
- Hongzhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xingang Bi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Wang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zejun Xiao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youyan Guan
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaopeng Guan
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Tian
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongsong Bai
- Department of Urology, Cancer Hospital of Huanxing Chaoyang District Beijing, Beijing, China
| | - Linjun Hu
- Department of Urology, Cancer Hospital of Huanxing Chaoyang District Beijing, Beijing, China
| | - Chuanzhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixing Jiang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhilong Hu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Chen
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shan Zheng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoli Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changling Li
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhui Ma
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yueping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aiping Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kim DW, Yoon SK, Kim SH. Urothelial Carcinoma of the Bladder: Radiologic Perspective. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1033-1052. [PMID: 36238404 PMCID: PMC9432377 DOI: 10.3348/jksr.2021.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
방광암은 비교적 흔히 진단되는 암이며 재발이 흔해 영상의학적 검사에서 흔히 만날 수 있다. 방광암의 정확한 진단과 병기 평가는 어떤 치료를 할 것인지를 정하고 예후를 평가하는데 큰 영향을 미친다. 방광암의 임상적 병기 평가는 요도경유방광종양절제술로 진단과 치료를 겸해서 이루어졌지만, 저평가되는 경우가 흔히 있다. 수술 전 방광암의 위치, 크기, 근육층 침범 유무, 림프절전이, 원격전이, 상부요로 암 유무 등을 영상의학적 검사에서 정확히 진단 및 평가할 수 있다면 더욱 적절히 처치 및 관리를 할 수 있다. 이런 정확한 진단을 위해서는 영상을 판독하는 영상의학과 의사는 먼저 방광암의 임상적인 특징을 잘 알고 있어야 한다. 그리고 영상 검사들의 종류와 특징, 한계를 알고 있어야 한다. 최근 자기공명영상의 발달로 방광 영상의 질 및 방광암의 진단과 평가가 향상되었다. 그리고 방광 이미징 보고 및 데이터시스템이 발표되어 객관적으로 방광암의 근육층 침범 가능성을 평가할 수 있게 되었다. 방광암 치료 종류를 알고 그에 따른 치료 후 변화에는 무엇이 있는지 어떻게 평가하는지도 알아야 하겠다. 이 종설에서는 방광 요로상피세포암의 특징과 다양한 영상의학 검사와 소견에 대해서 알아보고자 한다.
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Affiliation(s)
- Dong Won Kim
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Seong Kuk Yoon
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Sang Hyeon Kim
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
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Utilization of imaging for staging in bladder cancer: is there a role for MRI or PET-computed tomography? Curr Opin Urol 2020; 30:377-386. [PMID: 32168196 DOI: 10.1097/mou.0000000000000743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Accurate staging of bladder cancer is essential to guide appropriate management. In this review, we discuss the principles, applications and performance of multiparametric MRI (mpMRI) and PET-computer tomography (PET-CT) for local and distant staging of bladder cancer. RECENT FINDINGS Bladder mpMRI has a high diagnostic performance in local staging of bladder cancer, superior to other imaging modalities. It can accurately differentiate muscle invasive bladder cancer (MIBC) from non-MIBC (NMIBC), as well as ≤T2 from ≥T3 stages. mpMRI can be used to assess pelvic lymph nodes, although its sensitivity is relatively low. For the assessment of the upper urinary tract, CT urography is the imaging modality of choice. magnetic resonance urography is a viable alternative to CT in selected cases. Although PET-CT is accurate for nodal and distant staging of bladder cancer, there is no clear evidence on its superior diagnostic performance compared with contrast-enhanced CT. SUMMARY mpMRI is the most accurate imaging modality for local staging of bladder cancer, capable to accurately distinguish MIBC from NMIBC. Nodal and distant staging relies primarily on contrast-enhanced CT.
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Liu Y, Zheng H, Xu X, Zhang X, Du P, Liang J, Lu H. The invasion depth measurement of bladder cancer using T2-weighted magnetic resonance imaging. Biomed Eng Online 2020; 19:92. [PMID: 33287834 PMCID: PMC7720543 DOI: 10.1186/s12938-020-00834-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Invasion depth is an important index for staging and clinical treatment strategy of bladder cancer (BCa). The aim of this study was to investigate the feasibility of segmenting the BCa region from bladder wall region on MRI, and quantitatively measuring the invasion depth of the tumor mass in bladder lumen for further clinical decision-making. This retrospective study involved 20 eligible patients with postoperatively pathologically confirmed BCa. It was conducted in the following steps: (1) a total of 1159 features were extracted from each voxel of both the certain cancerous and wall tissues with the T2-weighted (T2W) MRI data; (2) the support vector machine (SVM)-based recursive feature elimination (RFE) method was implemented to first select an optimal feature subset, and then develop the classification model for the precise separation of the cancerous regions; (3) after excluding the cancerous region from the bladder wall, the three-dimensional bladder wall thickness (BWT) was calculated using Laplacian method, and the invasion depth of BCa was eventually defined by the subtraction of the mean BWT excluding the cancerous region and the minimum BWT of the cancerous region. RESULTS The segmented results showed a promising accuracy, with the mean Dice similarity coefficient of 0.921. The "soft boundary" defined by the voxels with the probabilities between 0.1 and 0.9 could demonstrate the overlapped region of cancerous and wall tissues. The invasion depth calculated from proposed segmentation method was compared with that from manual segmentation, with a mean difference of 0.277 mm. CONCLUSION The proposed strategy could accurately segment the BCa region, and, as the first attempt, realize the quantitative measurement of BCa invasion depth.
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Affiliation(s)
- Yang Liu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Haojie Zheng
- School of Life Sciences and Technology, Xidian University, 266 Xinglong Section of Xifeng Road, Xi'an, Shaanxi, 710126, PR China
| | - Xiaopan Xu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Xi Zhang
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Peng Du
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Jimin Liang
- School of Life Sciences and Technology, Xidian University, 266 Xinglong Section of Xifeng Road, Xi'an, Shaanxi, 710126, PR China.
| | - Hongbing Lu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China.
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Panebianco V, Pecoraro M, Del Giudice F, Takeuchi M, Muglia VF, Messina E, Cipollari S, Giannarini G, Catalano C, Narumi Y. VI-RADS for Bladder Cancer: Current Applications and Future Developments. J Magn Reson Imaging 2020; 55:23-36. [PMID: 32939939 DOI: 10.1002/jmri.27361] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 01/07/2023] Open
Abstract
Bladder cancer (BCa) is among the ten most frequent cancers globally. It is the tumor with the highest lifetime treatment-associated costs, and among the tumors with the heaviest impacts on postoperative quality of life. The purpose of this article is to review the current applications and future perspectives of the Vesical Imaging Reporting and Data System (VI-RADS). VI-RADS is a newly developed scoring system aimed at standardization of MRI acquisition, interpretation, and reporting for BCa. An insight will be given on the BCa natural history, current MRI applications for local BCa staging with assessment of muscle invasiveness, and clinical implications of the score for disease management. Future applications include risk stratification of nonmuscle invasive BCa, surveillance, and prediction and monitoring of therapy response. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza/Policlinico Umberto I, Rome, Italy
| | | | - Valdair F Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Stefano Cipollari
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
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Arita Y, Shigeta K, Akita H, Suzuki T, Kufukihara R, Kwee TC, Ishii R, Mikami S, Okuda S, Kikuchi E, Oya M, Jinzaki M. Clinical utility of the Vesical Imaging-Reporting and Data System for muscle-invasive bladder cancer between radiologists and urologists based on multiparametric MRI including 3D FSE T2-weighted acquisitions. Eur Radiol 2020; 31:875-883. [PMID: 32829418 DOI: 10.1007/s00330-020-07153-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/25/2020] [Accepted: 08/05/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To investigate the clinical utility of the Vesical Imaging-Reporting and Data System (VI-RADS) by comparing its diagnostic performance for muscle-invasive bladder cancer (MIBC) between radiologists and urologists based on multiparametric MRI, including three-dimensional (3D) fast spin-echo (FSE) T2-weighted acquisitions. METHODS This study included 66 treatment-naïve patients (60 men, 6 women; mean age 74.0 years) with pathologically proven bladder cancer who underwent multiparametric MRI, including 3D FSE T2-weighted imaging, before transurethral bladder tumour resection between January 2010 and November 2018. The MRI scans were categorised according to the five-point VI-RADS score by four independent readers (two board-certified radiologists and board-certified urologists each), blinded to the histopathological findings. The VI-RADS scores were compared with the postoperative histopathological diagnosis. Interobserver agreement was assessed using weighted kappa coefficients. ROC analysis and generalised estimating equations were used to evaluate the diagnostic performance. RESULTS Forty-nine (74.2%) and 17 (25.8%) tumours were confirmed to be non-MIBC and MIBC, respectively, based on pathological examination. The interobserver agreement was good-to-excellent between all pairs of readers (range, 0.73-0.91). The urologists' sensitivity/specificity values for DCE-MRI VI-RADS scores were significantly lower than those of radiologists. No significant differences were observed for the overall VI-RADS score. The AUC for the overall VI-RADS score was 0.94, 0.92, 0.89, and 0.87 for radiologists 1 and 2 and urologists 1 and 2, respectively. CONCLUSIONS The VI-RADS score, based on multiparametric MRI including 3D FSE T2-weighted acquisitions, can be useful for radiologists and urologists to determine the bladder cancer muscle invasion status preoperatively. KEY POINTS • VI-RADS (using multiparametric MRI including 3D FSE T2-weighted acquisitions) achieves good to excellent interobserver agreement and has similar diagnostic performance for detecting muscle invasion by both radiologists and urologists. • The diagnostic performance of the overall VI-RADS score is high for both radiologists and urologists, particularly due to the dominant effect of diffusion-weighted imaging on the overall VI-RADS score. • The sensitivity and specificity values of the T2WI VI-RADS scores for four readers in our study (using 3D FSE T2-weighted acquisitions) were similar (with slightly higher specificity values) to previously published results (using 2D FSE T2-weighted acquisitions).
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Hirotaka Akita
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tatsuya Suzuki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryohei Kufukihara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Ryota Ishii
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Shuji Mikami
- Department of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Bandini M, Calareso G, Raggi D, Marandino L, Colecchia M, Gallina A, Giannatempo P, Pederzoli F, Gandaglia G, Fossati N, Capitanio U, Colombo R, Salonia A, Briganti A, Montorsi F, De Cobelli F, Messina A, Necchi A. The Value of Multiparametric Magnetic Resonance Imaging Sequences to Assist in the Decision Making of Muscle-invasive Bladder Cancer. Eur Urol Oncol 2020; 4:829-833. [PMID: 32605888 DOI: 10.1016/j.euo.2020.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/02/2020] [Accepted: 06/13/2020] [Indexed: 11/30/2022]
Abstract
Interim data from the PURE-01 study, using pembrolizumab before radical cystectomy in muscle-invasive bladder cancer (MIBC), suggested that multiparametric magnetic resonance imaging (mpMRI) was able to predict the pathologic response. Owing to the availability of novel effective therapies in MIBC, the possibility to assess tumor response easily has become exceedingly important. The primary objective of the present study was to evaluate the association between individual and combined MRI sequences, and the pathologic response in the final PURE-01 population. Images were internally evaluated and the diagnostic performance was analyzed for separate sequences, along with their combination. From February 2017 to December 2019, 143 patients were enrolled in PURE-01, and 123 with suitable paired imaging assessments before and after pembrolizumab tests (N = 246 mpMRI in total) were analyzed in relation to the pathologic response. The area under the curve (AUC) of the combination of all sequences to predict ypT0ypN0 response was 0.74. By excluding dynamic contrast enhancement (DCE) assessment, the AUC was 0.74. When looking at ypT1/a/is ypN0 response, the AUC was 0.87 in both cases. Without DCE, 95% of patients with no evidence of disease resulted in ypT1/a/is ypN0 and 65% ypT0ypN0 responders. In conclusion, the final results confirmed the reliability of mpMRI and suggested the opportunity to avoid intravenous gadolinium contrast to personalize bladder-sparing strategies in radiologically complete responders. PATIENT SUMMARY: We evaluated the reliability of multiparametric bladder magnetic resonance imaging to predict the pathologic response to pembrolizumab administered before radical cystectomy in muscle-invasive bladder cancer. We observed that this radiologic examination is promising in the attempt to identify opportunities to spare the bladder in selected, radiologically defined complete responders. We also observed that the use of intravenous gadolinium contrast can be avoided in future studies. ClinicalTrials.gov, number NCT02736266.
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Affiliation(s)
- Marco Bandini
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Raggi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Laura Marandino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Maurizio Colecchia
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Gallina
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo Pederzoli
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Renzo Colombo
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Clinical and Experimental Radiology Unit, IRCCS San Raffaele Hospital, Milano, Italy
| | - Antonella Messina
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
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Juri H, Narumi Y, Panebianco V, Osuga K. Staging of bladder cancer with multiparametric MRI. Br J Radiol 2020; 93:20200116. [PMID: 32516554 DOI: 10.1259/bjr.20200116] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The distinction of non-muscle-invasive bladder cancer and muscle-invasive bladder cancer is important for the selection of the optimal treatment. Multiparametric MRI (mp-MRI) has been an useful modality for the T staging of bladder cancer, and a systematic evaluation of mp-MRI is needed. The Vesical Imaging Reporting and Data System was designed to standardize the scanning and reporting criteria based on mp-MRI for clinical and research applications. This review briefly describes the method, interpretation, and timing of mp-MRI examinations in the clinical settings. Validation studies of Vesical Imaging Reporting and Data System and future perspectives are also considered.
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Affiliation(s)
- Hiroshi Juri
- Department of Diagnostic Radiology, Osaka Medical College, Osaka, Japan
| | - Yoshifumi Narumi
- Department of Health Care, Kyoto Tachibana University, Kyoto, Japan
| | - Valeria Panebianco
- Department of Radiological Sciences Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical College, Osaka, Japan
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Abstract
OBJECTIVE. The purpose of this article is to review the natural history and management of bladder cancer, with insight into MRI applications for the assessment of muscle invasiveness of bladder cancer using the newly developed Vesical Imaging Reporting and Data System (VI-RADS) score. CONCLUSION. Multiparametric MRI and the VI-RADS score have been consistently validated across several different institutions as appropriate tools for local staging of bladder cancer and have been proven to contribute to the diagnostic workup and management of urinary bladder cancer.
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Carando R, Afferi L, Marra G, Krajewski W, Pagliarulo V, Abufaraj M, Xylinas E, Cathelineau X, Sanchez-Salas R, Moschini M. The effectiveness of multiparametric magnetic resonance imaging in bladder cancer (Vesical Imaging-Reporting and Data System): A systematic review. Arab J Urol 2020; 18:67-71. [PMID: 33029409 PMCID: PMC7473244 DOI: 10.1080/2090598x.2020.1733818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective To evaluate the role of the Vesical Imaging-Reporting and Data System (VI-RADS) score in the diagnostic pathway of bladder cancer. Methods A systemic search of the contemporary literature was performed in December 2019 using the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), and Web of Science databases focussing on all available articles on VI-RADS. Results Overall, six of 15 articles were included. All the available articles evaluated the ability of radiologists to use the VI-RADS score for discriminating non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC). Considering a cut-off VI-RADS score of >2, the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were 78-91.9%, 85-91%.1, 69-78%, and 88-97.1%, respectively. Considering a VI-RADS score cut-off of >3, the sensitivity, specificity, PPV and NPV were 77-94.6%, 43.9-96.5%, 51.6-86%, and 63.7-93%, respectively. Good interobserver agreement was demonstrated in the evaluated studies with a κ score of 0.73-0.89. Only one study evaluated the utility of VI-RADS in determining the presence of MIBC in patients treated with transurethral resection of the bladder diagnosed with high-grade T1 before the second transurethral resection using a VI-RADS score cut-off of >2; the sensitivity, specificity, PPV and NPV were 85%, 93.6%, 74.5%, and 96.6%, respectively. Conclusion The VI-RADS score, using multiparametric magnetic resonance imaging, showed excellent results in discriminating MIBC from NMIBC. Preliminary results have been reported for its use in patients with high-grade T1 bladder cancer. These results need to be validated in high-quality real-world settings. Abbreviations DCE: dynamic contrast enhancement; DWI: diffusion-weighted imaging; (N)MIBC: (non-)muscle-invasive bladder cancer; mpMRI: multiparametric MRI; TURBT: transurethral resection of bladder tumour; (N)(P)PV: (negative) (positive) predictive value; SC: structural category; T2W: T2-weighted; VI-RADS: vesical imaging-reporting and data system.
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Affiliation(s)
- Roberto Carando
- Department of Urology, Clinica Luganese Moncucco, Lugano, Switzerland.,Clinica S. Anna, Swiss Medical Group, Sorengo, Switzerland.,Ward of Surgery and Urology, Clinica S. Chiara, Locarno, Switzerland.,Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | | | - Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
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Caglic I, Panebianco V, Vargas HA, Bura V, Woo S, Pecoraro M, Cipollari S, Sala E, Barrett T. MRI of Bladder Cancer: Local and Nodal Staging. J Magn Reson Imaging 2020; 52:649-667. [PMID: 32112505 DOI: 10.1002/jmri.27090] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/24/2022] Open
Abstract
Accurate staging of bladder cancer (BC) is critical, with local tumor staging directly influencing management decisions and affecting prognosis. However, clinical staging based on clinical examination, including cystoscopy and transurethral resection of bladder tumor (TURBT), often understages patients compared to final pathology at radical cystectomy and lymph node (LN) dissection, mainly due to underestimation of the depth of local invasion and the presence of LN metastasis. MRI has now become established as the modality of choice for the local staging of BC and can be additionally utilized for the assessment of regional LN involvement and tumor spread to the pelvic bones and upper urinary tract (UUT). The recent development of the Vesical Imaging-Reporting and Data System (VI-RADS) recommendations has led to further improvements in bladder MRI, enabling standardization of image acquisition and reporting. Multiparametric magnetic resonance imaging (mpMRI) incorporating morphological and functional imaging has been proven to further improve the accuracy of primary and recurrent tumor detection and local staging, and has shown promise in predicting tumor aggressiveness and monitoring response to therapy. These sequences can also be utilized to perform radiomics, which has shown encouraging initial results in predicting BC grade and local stage. In this article, the current state of evidence supporting MRI in local, regional, and distant staging in patients with BC is reviewed. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:649-667.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Valeria Panebianco
- Department of Radiological, Oncological and Anatomo-pathological sciences, "Sapienza University", Rome, Italy
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Martina Pecoraro
- Department of Radiological, Oncological and Anatomo-pathological sciences, "Sapienza University", Rome, Italy
| | - Stefano Cipollari
- Department of Radiological, Oncological and Anatomo-pathological sciences, "Sapienza University", Rome, Italy
| | - Evis Sala
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Necchi A, Bandini M, Calareso G, Raggi D, Pederzoli F, Farè E, Colecchia M, Marandino L, Bianchi M, Gallina A, Colombo R, Fossati N, Gandaglia G, Capitanio U, Dehò F, Giannatempo P, Lucianò R, Salonia A, Madison R, Ali SM, Chung JH, Ross JS, Briganti A, Montorsi F, De Cobelli F, Messina A. Multiparametric Magnetic Resonance Imaging as a Noninvasive Assessment of Tumor Response to Neoadjuvant Pembrolizumab in Muscle-invasive Bladder Cancer: Preliminary Findings from the PURE-01 Study. Eur Urol 2019; 77:636-643. [PMID: 31882281 DOI: 10.1016/j.eururo.2019.12.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the PURE-01 study, pembrolizumab was given preoperatively before radical cystectomy in clinical T2-4aN0M0 patients. An accurate clinical response assessment may be useful for developing new perioperative strategies in these patients. OBJECTIVE To evaluate the association between bladder multiparametric magnetic resonance imaging (mpMRI) findings after pembrolizumab and the pathological complete response (CR; pT0). DESIGN, SETTING, AND PARTICIPANTS Patients were staged using bladder mpMRI whereby radiologists were asked to characterize the following parameters: residual disease at T1- and T2-weighted images (step 1: yes/no), presence of hyperintense spots within the bladder wall on diffusion-weighted imaging (step 2: yes/no), and presence of pathological contrast enhancement (step 3: yes/no), before and after three cycles of pembrolizumab. Examinations were internally assessed by two senior radiologists and externally evaluated by a third senior radiologist. INTERVENTION To evaluate bladder tumor response after neoadjuvant pembrolizumab, mpMRI was used. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary objective was to predict the pT0 after neoadjuvant pembrolizumab by relying on the mpMRI findings. Cohen's kappa statistics was used to assess interobserver variability. Univariable analyses for pT0 were performed including internal and external post-therapy mpMRI steps. RESULTS AND LIMITATIONS From February 2017 to October 2018, 82 patients (164 total mpMRI assessments) were analyzed. The agreement between the internal and external mpMRI assessments after therapy was acceptable (κ values ranging from 0.5 to 0.76). Each mpMRI step was significantly associated with pT0 in both internal and external assessments. In patients with CR/no evidence of residual disease (NED) in all internally evaluated mpMRI steps (N = 37), the pT0 was seen in 23 (62%), compared with 19 of 26 externally evaluated NED patients (73%). CONCLUSIONS In post-pembrolizumab muscle-invasive bladder cancer, mpMRI sequence assessment had acceptable interobserver variability and represented the basis for the proposal of a radiological CR/NED status definition predicting the pT0 response to pembrolizumab. After validation of these findings with external datasets, we propose this tool for developing bladder-sparing immunotherapy maintenance therapies. PATIENT SUMMARY Assessment of the extent of disease in patients with muscle-invasive bladder cancer using conventional imaging yields serious limitations. In the PURE-01 study, we evaluated the potential of bladder multiparametric magnetic resonance imaging (MRI) to predict the pathological complete response to neoadjuvant pembrolizumab. After validation with larger datasets, the proposed stepwise assessment incorporating multiparametric MRI sequences will be used at our center to develop bladder-sparing approaches in future studies.
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Affiliation(s)
- Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Marco Bandini
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo Pederzoli
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elena Farè
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Laura Marandino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Bianchi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Gallina
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Renzo Colombo
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Roberta Lucianò
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Siraj M Ali
- Foundation Medicine Inc., Cambridge, MA, USA
| | - Jon H Chung
- Foundation Medicine Inc., Cambridge, MA, USA
| | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, MA, USA; Upstate Medical University, Syracuse, NY, USA
| | - Alberto Briganti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy; Clinical and Experimental Radiology Unit, IRCCS San Raffaele Hospital, Milano, Italy
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Bedeutung der VI-RADS-Klassifikation für die Bildgebung beim Harnblasenkarzinom – Stand der Dinge. Urologe A 2019; 58:1443-1450. [DOI: 10.1007/s00120-019-01061-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Stage T1 bladder cancers invade the lamina propria of the bladder and, despite sharing many of the genetic features of muscle-invasive bladder cancers, are classified as non-muscle-invasive or 'superficial' tumours. Yet, patients with T1 bladder cancer have an overall mortality of 33% and a cancer-specific mortality of 14% at three years after diagnosis, suggesting that these patients have a high risk of progression and, accordingly, require meticulous surgery, endoscopic surveillance and clinical decision-making. We hypothesize that the variability in the outcomes of patients with T1 bladder cancer is a result of both tumour heterogeneity and pathological staging, as well as inconsistencies in risk stratification, endoscopic resection and schedules of delivery of BCG. Owing to limitations in clinical staging, patients with T1 bladder cancer are at risk of both undertreatment with persistent use of BCG despite recurrence, and overtreatment with early cystectomy. Understanding the molecular features of T1 bladder cancers and how they respond to BCG therapy could improve biomarkers for risk stratification to align therapy with biological risk.
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Makboul M, Farghaly S, Abdelkawi IF. Multiparametric MRI in differentiation between muscle invasive and non-muscle invasive urinary bladder cancer with vesical imaging reporting and data system (VI-RADS) application. Br J Radiol 2019; 92:20190401. [PMID: 31573328 DOI: 10.1259/bjr.20190401] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate role of multiparametric MRI (mp-MRI) in differentiation between invasive and non-invasive bladder cancer and accuracy of vesical imaging reporting and data system (VI-RADS) score. METHODS AND MATERIALS 50 patients diagnosed as cancer bladder were enrolled in this study, mp-MRI including conventional (T1 weighted imaging and high resolution T2 weighted imaging) and functional sequences (diffusion-weighted imaging and dynamic contrast enhanced-MRI) were done, all data were regrouped to evaluate the accuracy of each separate sequence and mp-MRI in distinguishing non-muscle invasive from muscle-invasive tumors, with VI-RADS score application and comparison with pathological findings, then interobserver agreement for detection of muscle invasion according to mp-MRI and VI-RADS scoring system findings was calculated. RESULTS Diagnostic accuracy of mp-MRI in differentiation between muscle invasive and non-muscle invasive bladder cancer was (84%) with highest sensitivity (78%), very good agreement between mp-MRI and histopathological data (k = 0.87), and highest area under curve (AUC) reaching 0.83, dynamic contrast enhanced-MRI sequence showed the highest accuracy in muscle invasion detection by (88%), with highest AUC 0.83. Diagnostic accuracy of VI-RADS score in detection of muscle invasion was 84%, with specificity and negative predictive value of 88% and AUC was 0.83. Interobserver agreement was strong as regard diagnostic performance of mp-MRI and VI-RADS scoring for detection of muscle invasion reaching (K = 0.82, p < 0.001) and (K = 0.87, p < 0.001) respectively. CONCLUSION mp-MRI is considered as comprehensive and effective tool for determination of muscle invasion in cases of urinary bladder cancer. Also VI-RADS scoring system can accurately differentiate between invasive and non-invasive bladder cancer. ADVANCES IN KNOWLEDGE The VI-RADS system was recently suggested for the uniform evaluation of muscle invasion in cancer bladder by mp-MRI. In this paper, we applied this system to 50 cases to evaluate its ease and compared the results with the histopathological findings for evaluation of its accuracy.
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Affiliation(s)
- Marwa Makboul
- Lecturer of radio diagnosis, Radio diagnosis department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shimaa Farghaly
- Lecturer of radio diagnosis, Radio diagnosis department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Islam F Abdelkawi
- Urology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Ueno Y, Takeuchi M, Tamada T, Sofue K, Takahashi S, Kamishima Y, Hinata N, Harada K, Fujisawa M, Murakami T. Diagnostic Accuracy and Interobserver Agreement for the Vesical Imaging-Reporting and Data System for Muscle-invasive Bladder Cancer: A Multireader Validation Study. Eur Urol 2019; 76:54-56. [DOI: 10.1016/j.eururo.2019.03.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/08/2019] [Indexed: 11/30/2022]
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Gordon PC, Thomas F, Noon AP, Rosario DJ, Catto JW. Long-term Outcomes from Re-resection for High-risk Non–muscle-invasive Bladder Cancer: A Potential to Rationalize Use. Eur Urol Focus 2019; 5:650-657. [DOI: 10.1016/j.euf.2017.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/14/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
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46
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Sushentsev N, Tanner J, Slough RA, Kozlov V, Gill AB, Barrett T. The Effect of Different Drinking and Voiding Preparations on Magnetic Resonance Imaging Bladder Distention in Normal Volunteers and Patients. Can Assoc Radiol J 2018; 69:383-389. [PMID: 30318460 DOI: 10.1016/j.carj.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/12/2018] [Accepted: 07/21/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nikita Sushentsev
- International School "Medicine of the Future", Sechenov First Moscow State Medical University, Moscow, Russia.
| | - James Tanner
- Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Rhys A Slough
- Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Vasily Kozlov
- Department of Public Health and Healthcare Organization, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrew B Gill
- Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Tristan Barrett
- International School "Medicine of the Future", Sechenov First Moscow State Medical University, Moscow, Russia; Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom; CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
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47
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Frączek M, Kamecki H, Kamecka A, Sosnowski R, Sklinda K, Czarniecki M, Królicki L, Walecki J. Evaluation of lymph node status in patients with urothelial carcinoma-still in search of the perfect imaging modality: a systematic review. Transl Androl Urol 2018; 7:783-803. [PMID: 30456182 PMCID: PMC6212628 DOI: 10.21037/tau.2018.08.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
While accurate lymph node status evaluation in urothelial carcinoma patients is essential for the correct disease staging and, hence, establishing the most beneficial treatment strategy, the diagnostic performance of routine imaging in regards to this issue is not satisfactory. For the purpose of this article, we systematically reviewed the contemporary literature on the sensitivity and specificity of particular imaging modalities which have been studied for detecting lymph node metastases in patients diagnosed with urothelial carcinoma. The evidence reviewed shows that computed tomography (CT), although recognized as the imaging modality of choice, is associated with marked limitations, resulting in its low sensitivity for lymph node involvement detection in urothelial carcinoma patients, with no study reporting a value higher than 46% using standard cut-off values. Markedly higher sensitivity rates may be achieved with magnetic resonance imaging (MRI), especially when using ultrasmall superparamagnetic iron oxide as the contrast agent, however, no uniform protocol has been systematically studied up to date. The vast majority of recent evidence concerns positron emission tomography (PET), which is being reported to improve the diagnostic performance of CT alone, as has been demonstrated in multiple articles, which investigated the accuracy of PET/CT at primary or post-treatment staging of urothelial carcinoma patients. However, there has been substantial heterogeneity in terms of methodology and results between those studies, making it premature to draw any definitive conclusions. The results of this review lead to a conclusion, that while CT, despite being not fully satisfactory, still remains the gold-standard method of imaging for staging purposes in urothelial carcinoma, other imaging modalities are under investigation, with promising results.
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Affiliation(s)
- Michał Frączek
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Hubert Kamecki
- Department of Urogenital Cancer, Oncology Center-M. Skłodowska-Curie Institute, Warsaw, Poland
| | - Anna Kamecka
- Department of Pediatric Radiology, Public Children's Teaching Hospital, Warsaw, Poland
| | - Roman Sosnowski
- Department of Urogenital Cancer, Oncology Center-M. Skłodowska-Curie Institute, Warsaw, Poland
| | - Katarzyna Sklinda
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leszek Królicki
- Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy Walecki
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
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Panebianco V, Narumi Y, Altun E, Bochner BH, Efstathiou JA, Hafeez S, Huddart R, Kennish S, Lerner S, Montironi R, Muglia VF, Salomon G, Thomas S, Vargas HA, Witjes JA, Takeuchi M, Barentsz J, Catto JWF. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System). Eur Urol 2018; 74:294-306. [PMID: 29755006 PMCID: PMC6690492 DOI: 10.1016/j.eururo.2018.04.029] [Citation(s) in RCA: 316] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/26/2018] [Indexed: 01/10/2023]
Abstract
CONTEXT Management of bladder cancer (BC) is primarily driven by stage, grade, and biological potential. Knowledge of each is derived using clinical, histopathological, and radiological investigations. This multimodal approach reduces the risk of error from one particular test, but may present a staging dilemma when results conflict. Multiparametric magnetic resonance imaging (mpMRI) may improve patient care through imaging of the bladder with better resolution of the tissue planes than computed tomography and without radiation exposure. OBJECTIVE To define a standardized approach to imaging and reporting mpMRI for BC, by developing a VI-RADS score. EVIDENCE ACQUISITION We created VI-RADS (Vesical Imaging-Reporting And Data System) through consensus using existing literature. EVIDENCE SYNTHESIS We describe standard imaging protocols and reporting criteria (including size, location, multiplicity, and morphology) for bladder mpMRI. We propose a five-point VI-RADS score, derived using T2-weighted MRI, diffusion-weighted imaging, and dynamic contrast enhancement, which suggests the risks of muscle invasion. We include sample images used to understand VI-RADS. CONCLUSIONS We hope that VI-RADS will standardize reporting, facilitate comparisons between patients, and in future years, will be tested and refined if necessary. While we do not advocate mpMRI for all patients with BC, this imaging may compliment pathology or reduce radiation-based imaging. Bladder mpMRI may be most useful in patients with non-muscle-invasive cancers, in expediting radical treatment or for determining response to bladder-sparing approaches. PATIENT SUMMARY Magnetic resonance imaging (MRI) scans for bladder cancer are becoming more common and may provide accurate information that helps improve patient care. Here, we describe a standardized reporting criterion for bladder MRI. This should improve communication between doctors and allow better comparisons between patients.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy.
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bernard H Bochner
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shaista Hafeez
- The Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Robert Huddart
- The Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Steve Kennish
- Department of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Seth Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Valdair F Muglia
- Imaging Division, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Georg Salomon
- Martini Clinic, University Clinic Hamburg Eppendorf, Hamburg, Germany
| | - Stephen Thomas
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | | | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jelle Barentsz
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
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Fernández MI, Brausi M, Clark PE, Cookson MS, Grossman HB, Khochikar M, Kiemeney LA, Malavaud B, Sanchez-Salas R, Soloway MS, Svatek RS, Vikram R, Vrieling A, Kamat AM. Epidemiology, prevention, screening, diagnosis, and evaluation: update of the ICUD-SIU joint consultation on bladder cancer. World J Urol 2018; 37:3-13. [PMID: 30105454 DOI: 10.1007/s00345-018-2436-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/06/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To update current recommendations on prevention, screening, diagnosis, and evaluation of bladder cancer (BC) based on a thorough assessment of the most recent literature on these topics. METHODS A non-systematic review was performed, including articles until June 2017. A variety of original articles, reviews, and editorials were selected according to their epidemiologic, demographic, and clinical relevance. Assessment of the level of evidence and grade of recommendations was performed according to the International Consultation on Urological Diseases grading system. RESULTS BC is the ninth most common cancer worldwide with 430,000 new cases in 2012. Currently, approximately 165,000 people die from the disease annually. Absolute incidence and prevalence of BC are expected to rise significantly during the next decades because of population ageing. Tobacco smoking is still the main risk factor, accounting for about 50% of cases. Smoking cessation is, therefore, the most relevant recommendation in terms of prevention, as the risk of developing BC drops almost 40% within 5 years of cessation. BC screening is not recommended for the general population. BC diagnosis remains mainly based on cystoscopy, but development of new endoscopic and imaging technologies may rapidly change the diagnosis algorithm. The same applies for local, regional, and distant staging modalities. CONCLUSIONS A thorough understanding of epidemiology, risk factors, early detection strategies, diagnosis, and evaluation is essential for correct, evidence-based management of BC patients. Recent developments in endoscopic techniques and imaging raise the hope for providing better risk-adopted approaches and thereby improving clinical outcomes.
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Affiliation(s)
- Mario I Fernández
- Department of Urology, Clínica Alemana, Santiago, Chile.,Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Peter E Clark
- Department of Urology, Atrium Health, Levine Cancer Institute, Charlotte, NC, USA
| | - Michael S Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center & The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - H Barton Grossman
- Department of Urology, Unit 1373, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77030, USA
| | - Makarand Khochikar
- Department of Urology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bernard Malavaud
- Department of Urology, Toulouse Cancer Institute, Toulouse, France
| | | | - Mark S Soloway
- Department of Urology, Memorial Healthcare System, Miami, FL, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Raghunandan Vikram
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alina Vrieling
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ashish M Kamat
- Department of Urology, Unit 1373, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77030, USA.
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Wakai K, Utsumi T, Yoneda K, Oka R, Endo T, Yano M, Fujimura M, Kamiya N, Sekita N, Mikami K, Sugano I, Hiruta N, Suzuki H. Development and external validation of a nomogram to predict high-grade papillary bladder cancer before first-time transurethral resection of the bladder tumor. Int J Clin Oncol 2018; 23:957-964. [DOI: 10.1007/s10147-018-1299-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
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