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Zhang T, Zhu J, Li Z, Zhao Y, Li Y, Li J, He Q, Geng Y, Lu W, Zhang L, Li Z. The UF-5000 Atyp.C parameter is an independent risk factor for bladder cancer. Sci Rep 2024; 14:12659. [PMID: 38830942 PMCID: PMC11148171 DOI: 10.1038/s41598-024-63572-0] [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: 12/29/2023] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
Bladder carcinoma (BC) accounts for > 90% of all urothelial cancers. Pathological diagnosis through cytoscopic biopsy is the gold standard, whereas non-invasive diagnostic tools remain lacking. The "Atyp.C" parameter of the Sysmex UF-5000 urine particle analyzer represents the ratio of nucleus to cytoplasm and can be employed to detect urinary atypical cells. The present study examined the association between urinary Atyp.C values and BC risk. This two-center, retrospective case-control study identified clinical primary or newly recurrent BC (study period, 2022-2023; n = 473) cases together with controls with urinary tract infection randomly matched by age and sex (1:1). Urinary sediment differences were compared using non-parametric tests. The correlations between urinary Atyp.C levels and BC grade or infiltration were analyzed using Spearman's rank correlation. The BC risk factor odds ratio of Atyp.C was calculated using conditional logistic regression, and potential confounder effects were adjusted using stepwise logistic regression (LR). Primary risk factors were identified by stratified analysis according to pathological histological diagnosis. The mean value of urinary Atyp.C in BC cases (1.30 ± 3.12) was 8.7 times higher than that in the controls (0.15 ± 0.68; P < 0.001). Urinary Atyp.C values were positively correlated with BC pathological grade and invasion (r = 0.360, P < 0.001; r = 0.367, P < 0.001). Urinary Atyp.C was an independent risk factor for BC and closely related with BC pathological grade and invasion. Elevated urinary Atyp.C values was an independent risk factor for BC. Our findings support the use of Atyp.C as a marker that will potentially aid in the early diagnosis and long-term surveillance of new and recurrent BC cases.
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Affiliation(s)
- Tong Zhang
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Jianhong Zhu
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Zhaoxing Li
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Ya Zhao
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yan Li
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Jing Li
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Qian He
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yan Geng
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Wei Lu
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Lei Zhang
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Zhenzhen Li
- Department of Clinical Laboratory, Second Hospital, Xi'an Jiaotong University, Xi'an, 710004, China.
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Qureshi TA, Chen X, Xie Y, Murakami K, Sakatani T, Kita Y, Kobayashi T, Miyake M, Knott SRV, Li D, Rosser CJ, Furuya H. MRI/RNA-Seq-Based Radiogenomics and Artificial Intelligence for More Accurate Staging of Muscle-Invasive Bladder Cancer. Int J Mol Sci 2023; 25:88. [PMID: 38203254 PMCID: PMC10778815 DOI: 10.3390/ijms25010088] [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: 11/06/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Accurate staging of bladder cancer assists in identifying optimal treatment (e.g., transurethral resection vs. radical cystectomy vs. bladder preservation). However, currently, about one-third of patients are over-staged and one-third are under-staged. There is a pressing need for a more accurate staging modality to evaluate patients with bladder cancer to assist clinical decision-making. We hypothesize that MRI/RNA-seq-based radiogenomics and artificial intelligence can more accurately stage bladder cancer. A total of 40 magnetic resonance imaging (MRI) and matched formalin-fixed paraffin-embedded (FFPE) tissues were available for analysis. Twenty-eight (28) MRI and their matched FFPE tissues were available for training analysis, and 12 matched MRI and FFPE tissues were used for validation. FFPE samples were subjected to bulk RNA-seq, followed by bioinformatics analysis. In the radiomics, several hundred image-based features from bladder tumors in MRI were extracted and analyzed. Overall, the model obtained mean sensitivity, specificity, and accuracy of 94%, 88%, and 92%, respectively, in differentiating intra- vs. extra-bladder cancer. The proposed model demonstrated improvement in the three matrices by 17%, 33%, and 25% and 17%, 16%, and 17% as compared to the genetic- and radiomic-based models alone, respectively. The radiogenomics of bladder cancer provides insight into discriminative features capable of more accurately staging bladder cancer. Additional studies are underway.
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Affiliation(s)
- Touseef Ahmad Qureshi
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.A.Q.); (Y.X.); (D.L.)
- Department of Biomedical Science, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (X.C.); (S.R.V.K.)
| | - Xingyu Chen
- Department of Biomedical Science, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (X.C.); (S.R.V.K.)
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.A.Q.); (Y.X.); (D.L.)
| | - Kaoru Murakami
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (K.M.); (T.S.)
- Department of Urology, Kyoto University, Kyoto 606-8507, Japan; (Y.K.); (T.K.)
| | - Toru Sakatani
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (K.M.); (T.S.)
| | - Yuki Kita
- Department of Urology, Kyoto University, Kyoto 606-8507, Japan; (Y.K.); (T.K.)
| | - Takashi Kobayashi
- Department of Urology, Kyoto University, Kyoto 606-8507, Japan; (Y.K.); (T.K.)
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan;
| | - Simon R. V. Knott
- Department of Biomedical Science, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (X.C.); (S.R.V.K.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (K.M.); (T.S.)
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.A.Q.); (Y.X.); (D.L.)
| | - Charles J. Rosser
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (K.M.); (T.S.)
| | - Hideki Furuya
- Department of Biomedical Science, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (X.C.); (S.R.V.K.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (K.M.); (T.S.)
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Li L, Zhang J, Zhe X, Chang H, Tang M, Lei X, Zhang L, Zhang X. An MRI-based radiomics nomogram in predicting histologic grade of non-muscle-invasive bladder cancer. Front Oncol 2023; 13:1025972. [PMID: 37007156 PMCID: PMC10060523 DOI: 10.3389/fonc.2023.1025972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundNon-muscle-invasive bladder cancer (NMIBC) is categorized into high and low grades with different clinical treatments and prognoses. Thus, accurate preoperative evaluation of the histologic NMIBC grade through imaging techniques is essential.ObjectivesTo develop and validate an MRI-based radiomics nomogram for individualized prediction of NMIBC grading.MethodsThe study included 169 consecutive patients with NMIBC (training cohort: n = 118, validation cohort: n = 51). A total of 3148 radiomic features were extracted, and one-way analysis of variance and least absolute shrinkage and selection operator were used to select features for building the radiomics score(Rad-score). Three models to predict NMIBC grading were developed using logistic regression analysis: a clinical model, a radiomics model and a radiomics–clinical combined nomogram model. The discrimination and calibration power and clinical applicability of the models were evaluated. The diagnostic performance of each model was compared by determining the area under the curve (AUC) in receiver operating characteristic (ROC) curve analysis.ResultsA total of 24 features were used to build the Rad-score. A clinical model, a radiomics model, and a radiomics–clinical nomogram model that incorporated the Rad-score, age, and number of tumors were constructed. The radiomics model and nomogram showed AUCs of 0.910 and 0.931 in the validation set, which outperformed the clinical model (0.745). The decision curve analysis also showed that the radiomics model and combined nomogram model yielded higher net benefits than the clinical model.ConclusionA radiomics–clinical combined nomogram model has the potential to be used as a non-invasive tool for the differentiating low-from high-grade NMIBCs.
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Affiliation(s)
| | | | | | | | | | | | - Li Zhang
- *Correspondence: Li Zhang, ; Xiaoling Zhang,
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Preoperative CT features to predict risk stratification of non-muscle invasive bladder cancer. Abdom Radiol (NY) 2023; 48:659-668. [PMID: 36454277 DOI: 10.1007/s00261-022-03730-y] [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: 07/19/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To investigate whether preoperative CT features can be used to predict risk stratification of non-muscle invasive bladder cancer (NMIBC). METHODS The 168 patients with pathologically confirmed NMIBC who underwent preoperative CT urography were retrospectively analyzed and were divided into training (n = 117) and testing (n = 51) sets. According to the European Association of Urology Guidelines, patients were classified into low-risk (n = 50), medium-risk (n = 23), and high-risk (n = 95) groups. A random over-sample was performed to handle the offset caused by the unbalanced groups. We measured some CT features that may help stratify which for modeling were determined using an F-test-based feature selection with a tenfold cross-validation procedure, and the Gaussian Naive Bayes model was trained on the entire training set. In the testing set, the performance of the model was evaluated. RESULTS The selected CT features were the maximum and the minimum diameter of the largest tumor, whether the largest tumor is located at the trigone, and tumor number. In the testing set, the model reached a macro- and micro- AUC of 0.783 and 0.745 with an accuracy of 0.529. As for the one-vs-rest problem, the model was most effective in identifying low-risk individuals, with an AUC, accuracy, sensitivity, and specificity of 0.870, 0.647, 1.000, and 0.438, respectively; the medium-risk group reached 0.814, 0.882, 0.250, and 0.936, respectively; the identification of the high-risk group was harder, going 0.665, 0.529, 0.250, and 0.870, respectively. CONCLUSION It is feasible to predict the risk stratification of NMIBC using preoperative CT features.
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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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Kizilgoz V, Kantarci M, Tonkaz G, Levent A, Ogul H. Incidental findings on prostate MRI: a close look at the field of view in this anatomical region. Acta Radiol 2022; 64:1676-1693. [PMID: 36226365 DOI: 10.1177/02841851221131243] [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: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has been widely used as an advanced imaging modality to detect prostate cancer and indicate suspicious areas to guide biopsy procedures. The increasing number of prostate examinations with MRI has provided an opportunity to detect incidental lesions, and some might be very significant to elucidate patient symptoms or occult neoplastic process in the early stages. These incidental lesions might be located in the prostate gland, adjacent tissues, or organs around the prostate gland or out of the genitourinary system. The field of view of prostate MRI includes not only the prostate gland but also other critical pelvic organs in this specific anatomical region. Some of these incidental lesions might cause the same symptoms as prostate cancer and might explain the symptoms of the patient, and some might indicate early cancer stages located outside the prostate. Reporting these lesions might be life-saving by initiating early disease treatment. Awareness of the predicted locations of congenital anomalies would also be beneficial for the radiologists to mention these incidental findings.
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Affiliation(s)
- Volkan Kizilgoz
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Mecit Kantarci
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey.,Faculty of Medicine, Department of Radiology, 37503Atatürk University, Erzurum, Turkey
| | - Gokhan Tonkaz
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Akin Levent
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey.,Faculty of Medicine, Department of Radiology, 37503Atatürk University, Erzurum, Turkey
| | - Hayri Ogul
- Faculty of Medicine, Department of Radiology, Düzce University, Düzce, Turkey
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Gupta R, Mahajan M, Sharma P, Bhardwaj S, Gupta V, Mahajan A. Application of Vesical Imaging-Reporting and Data System in Evaluation of Urinary Bladder Cancer Using Multiparametric Magnetic Resonance Imaging: A Hospital-Based Cross-Sectional Study. Avicenna J Med 2022; 12:162-168. [PMID: 36570433 PMCID: PMC9771629 DOI: 10.1055/s-0042-1755334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (mp-MRI) of urinary bladder (UB) is a novel imaging to predict detrusor muscle invasion in Bladder cancer (BC). The Vesical Imaging-Reporting and Data System (VI-RADS) was introduced in 2018 to standardize the reporting of BC with mp-MRI and to diagnose muscle invasion. This study was performed to evaluate the role of mp-MRI using VI-RADS to predict muscle invasive BC. Methods This prospective study was carried from June 2020 to May 2021 in a tertiary care institute. Thirty-six patients with untreated BC underwent mp-MRI followed by transuretheral resection of the tumor (TURBT). Mp-MRI findings were evaluated by two radiologists and BC was categorized according to VI-RADS scoring system. Resected tumors along with separate biopsy from the base were reported by two pathologists. Histopathological findings were compared with VI-RADS score and the performance of VI-RADS for determining detrusor muscle invasion was analyzed. Results VI-RADS scores of 4 and 5 were assigned to 9 (25%) and 15 (41.7%) cases, respectively, while 4 (13.3%) cases had VI-RADS score 3 on mp-MRI. VI-RADS 1 and 2 lesions were observed in six (16.7%) and two (5.5%) cases, respectively. On histopathology, 23 cases (63.9%) had muscle-invasive cancer and 13 cases (36.1%) had non-muscle-invasive cancer. The sensitivity and diagnostic accuracy of mp-MRI in predicting muscle invasive BC was 95.6 and 80.6%, respectively. Conclusion Mp-MRI has high sensitivity and diagnostic accuracy in predicting muscle invasive BC and should be advocated for evaluation of BC prior to surgery.
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Affiliation(s)
- Rahul Gupta
- Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Manik Mahajan
- Department of Radio-Diagnosis and Imaging, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Poonam Sharma
- Department of Pathology, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India,Address for correspondence Poonam Sharma, MD House no. 109, Sector 7, Channi Himmat, Jammu (J&K) 180015India
| | - Subhash Bhardwaj
- Department of Pathology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Vikrant Gupta
- Department of Radiology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Arti Mahajan
- Department of Anaesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
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Radiologic Diagnosis and Staging of Bladder Cancer: An Update. J Comput Assist Tomogr 2022; 46:530-544. [PMID: 35723651 DOI: 10.1097/rct.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although cystoscopic biopsy is the standard of care for initial diagnosis and local staging of bladder cancer, radiologic imaging plays a major role in identifying local invasion, nodal status, distant metastasis, and posttreatment surveillance. Recent development of the Vesical Imaging-Reporting and Data System for interpretation of multiparametric magnetic resonance imaging of the bladder has expanded the role diagnostic imaging in the management of bladder cancer. This article reviews multimodality imaging appearances, staging, and differential diagnosis of bladder cancer.
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Baressi Šegota S, Lorencin I, Smolić K, Anđelić N, Markić D, Mrzljak V, Štifanić D, Musulin J, Španjol J, Car Z. Semantic Segmentation of Urinary Bladder Cancer Masses from CT Images: A Transfer Learning Approach. BIOLOGY 2021; 10:biology10111134. [PMID: 34827126 PMCID: PMC8614660 DOI: 10.3390/biology10111134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 01/11/2023]
Abstract
Simple Summary Bladder cancer is a common cancer of the urinary tract, characterized by high metastatic potential and recurrence. The research applies a transfer learning approach on CT images (frontal, axial, and saggital axes) for the purpose of semantic segmentation of areas affected by bladder cancer. A system consisting of AlexNet network for plane recognition, using transfer learning-based U-net networks for the segmentation task. Achieved results show that the proposed system has a high performance, suggesting possible use in clinical practice. Abstract Urinary bladder cancer is one of the most common cancers of the urinary tract. This cancer is characterized by its high metastatic potential and recurrence rate. Due to the high metastatic potential and recurrence rate, correct and timely diagnosis is crucial for successful treatment and care. With the aim of increasing diagnosis accuracy, artificial intelligence algorithms are introduced to clinical decision making and diagnostics. One of the standard procedures for bladder cancer diagnosis is computer tomography (CT) scanning. In this research, a transfer learning approach to the semantic segmentation of urinary bladder cancer masses from CT images is presented. The initial data set is divided into three sub-sets according to image planes: frontal (4413 images), axial (4993 images), and sagittal (996 images). First, AlexNet is utilized for the design of a plane recognition system, and it achieved high classification and generalization performances with an AUCmicro¯ of 0.9999 and σ(AUCmicro) of 0.0006. Furthermore, by applying the transfer learning approach, significant improvements in both semantic segmentation and generalization performances were achieved. For the case of the frontal plane, the highest performances were achieved if pre-trained ResNet101 architecture was used as a backbone for U-net with DSC¯ up to 0.9587 and σ(DSC) of 0.0059. When U-net was used for the semantic segmentation of urinary bladder cancer masses from images in the axial plane, the best results were achieved if pre-trained ResNet50 was used as a backbone, with a DSC¯ up to 0.9372 and σ(DSC) of 0.0147. Finally, in the case of images in the sagittal plane, the highest results were achieved with VGG-16 as a backbone. In this case, DSC¯ values up to 0.9660 with a σ(DSC) of 0.0486 were achieved. From the listed results, the proposed semantic segmentation system worked with high performance both from the semantic segmentation and generalization standpoints. The presented results indicate that there is the possibility for the utilization of the semantic segmentation system in clinical practice.
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Affiliation(s)
- Sandi Baressi Šegota
- Faculty of Engineering, University of Rijeka, Vukovarska 58, 51000 Rijeka, Croatia; (S.B.Š.); (I.L.); (N.A.); (D.Š.); (J.M.); (Z.C.)
| | - Ivan Lorencin
- Faculty of Engineering, University of Rijeka, Vukovarska 58, 51000 Rijeka, Croatia; (S.B.Š.); (I.L.); (N.A.); (D.Š.); (J.M.); (Z.C.)
| | - Klara Smolić
- Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; (K.S.); (D.M.); (J.Š.)
| | - Nikola Anđelić
- Faculty of Engineering, University of Rijeka, Vukovarska 58, 51000 Rijeka, Croatia; (S.B.Š.); (I.L.); (N.A.); (D.Š.); (J.M.); (Z.C.)
| | - Dean Markić
- Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; (K.S.); (D.M.); (J.Š.)
- Faculty of Medicine, Branchetta 20/1, University of Rijeka, 51000 Rijeka, Croatia
| | - Vedran Mrzljak
- Faculty of Engineering, University of Rijeka, Vukovarska 58, 51000 Rijeka, Croatia; (S.B.Š.); (I.L.); (N.A.); (D.Š.); (J.M.); (Z.C.)
- Correspondence: ; Tel.: +385-51-651551
| | - Daniel Štifanić
- Faculty of Engineering, University of Rijeka, Vukovarska 58, 51000 Rijeka, Croatia; (S.B.Š.); (I.L.); (N.A.); (D.Š.); (J.M.); (Z.C.)
| | - Jelena Musulin
- Faculty of Engineering, University of Rijeka, Vukovarska 58, 51000 Rijeka, Croatia; (S.B.Š.); (I.L.); (N.A.); (D.Š.); (J.M.); (Z.C.)
| | - Josip Španjol
- Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; (K.S.); (D.M.); (J.Š.)
- Faculty of Medicine, Branchetta 20/1, University of Rijeka, 51000 Rijeka, Croatia
| | - Zlatan Car
- Faculty of Engineering, University of Rijeka, Vukovarska 58, 51000 Rijeka, Croatia; (S.B.Š.); (I.L.); (N.A.); (D.Š.); (J.M.); (Z.C.)
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Usefulness of advanced monoenergetic reconstruction technique in dual-energy computed tomography for detecting bladder cancer. Jpn J Radiol 2021; 40:177-183. [PMID: 34515925 PMCID: PMC8803668 DOI: 10.1007/s11604-021-01195-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
Purpose Detecting bladder cancer (BC) in routine CT images is important but is sometimes difficult when cancer is small. We evaluated the ability of 40-keV advanced monoenergetic images to depict BC.
Materials and methods Fifty-two patients with a median age of 74 years (range 45–92) who were diagnosed as BC with transurethral resection or cystectomy, were included. They were examined with contrast-enhanced dual-energy CT (DE-CT) and advanced virtual monoenergetic images (40 keV) were reconstructed. For evaluating depictability of BC on 40-keV or virtual-120-kVp images, the difference in CT number between the cancer and bladder wall (BC–BW value) were calculated. We also subjectively assessed depictability of BC in virtual-120-kVp and 40-keV images using a 4-grade Likert scale (3: clear, 0: not visualized).
Results In 42 of 52 patients, BC–BW values could be calculated because BC was detected on CT images. The mean BC–BW value at 40 keV was significantly higher than that of virtual 120 kVp [80.5 ± 54 (SD) vs. 11.4 ± 12.5 HU, P < 0.01]. Average scores of subjective evaluations in the virtual-120-kVp and 40-keV images were 1.7 ± 1.2 and 2.1 ± 1.2, respectively (P < 0.001). Conclusion The advanced monoenergetic reconstruction technique reconstructed using DE-CT image is useful to depict BC.
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ACR Appropriateness Criteria® Post-Treatment Surveillance of Bladder Cancer: 2021 Update. J Am Coll Radiol 2021; 18:S126-S138. [PMID: 33958107 DOI: 10.1016/j.jacr.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 02/05/2023]
Abstract
Urothelial cancer is the second most common cancer, and cause of cancer death, related to the genitourinary tract. The goals of surveillance imaging after the treatment of urothelial cancer of the urinary bladder are to detect new or previously undetected urothelial tumors, to identify metastatic disease, and to evaluate for complications of therapy. For surveillance, patients can be stratified into one of three groups: 1) nonmuscle invasive bladder cancer with no symptoms or additional risk factors; 2) nonmuscle invasive bladder cancer with symptoms or additional risk factors; and 3) muscle invasive bladder cancer. This document is a review of the current literature for urothelial cancer and resulting recommendations for surveillance imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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12
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Wolfman DJ, Marko J, Nikolaidis P, Khatri G, Dogra VS, Ganeshan D, Goldfarb S, Gore JL, Gupta RT, Heilbrun ME, Lyshchik A, Purysko AS, Savage SJ, Smith AD, Wang ZJ, Wong-You-Cheong JJ, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Hematuria. J Am Coll Radiol 2021; 17:S138-S147. [PMID: 32370958 DOI: 10.1016/j.jacr.2020.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
Hematuria is a common reason for patients to be referred for imaging of the urinary tract. All patients diagnosed with hematuria should undergo a thorough history and physical examination, urinalysis, and serologic testing prior to any initial imaging. Ultrasound, CT, and MRI are the most common imaging modalities used to evaluate hematuria. This document discusses the following clinical scenarios for hematuria: initial imaging of microhematuria without risk factors or history of recent vigorous exercise, or presence of infection, or viral illness, or present or recent menstruation; initial imaging of microhematuria in patients with known risk factors and no history of recent vigorous exercise, or presence of infection, or viral illness, or present or recent menstruation or renal parenchymal disease; initial imaging of microhematuria in the pregnant patient and initial imaging of gross hematuria. Follow-up of normal or abnormal findings is beyond the scope of this review. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Darcy J Wolfman
- Johns Hopkins University School of Medicine, Washington, District of Columbia.
| | - Jamie Marko
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | | | - Gaurav Khatri
- Panel Vice-Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | | | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | | | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | | | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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Han BH, Park SB, Chang IH, Chi BH, Park HJ, Lee ES. Urothelial-phase thin-section MDCT of the bladder in patients with hematuria: added value of multiplanar reformatted images. Abdom Radiol (NY) 2021; 46:2025-2031. [PMID: 33079253 DOI: 10.1007/s00261-020-02819-6] [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: 06/14/2020] [Revised: 10/04/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of MDCT with axial images and multiplanar reformatted (MPR) images from the urothelial phase of the bladder in patients with hematuria using cystoscopy as the reference standard. MATERIALS AND METHODS Our IRB for human investigation approved this study, and informed consent was waived. We included 192 patients (121 men, 71 women; age range 17-90 years; mean age ± SD: 60 ± 14 years) who underwent contrast-enhanced MDCT (scan delay: 70 s; section thickness: 2 mm) and conventional cystoscopy examination for painless gross hematuria or recurrent microscopic hematuria. Two radiologists in consensus interpreted the images for the presence or absence of bladder lesions. Using the kappa statistic, the patient-based agreement was determined between the CT and cystoscopic findings. We compared the diagnostic performance of axial images to those with coronal and sagittal reformations to detect bladder lesions. RESULTS MDCT showed excellent agreement between cystoscopy-axial scans (κ = 0.896) and axial with reformatted images (κ = 0.948). The sensitivity, specificity, and accuracy of MDCT were 94%, 96%, and 95% in the axial scans and 98%, 97%, and 97% in the axial with reformatted images, respectively. All statistical parameters of diagnostic performance were similar between the axial and the reformatted images (p > .05). CONCLUSION Axial MDCT imaging demonstrates high diagnostic performance in detecting bladder lesions, but additional reformatted images can improve diagnostic accuracy.
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14
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Wong VK, Ganeshan D, Jensen CT, Devine CE. Imaging and Management of Bladder Cancer. Cancers (Basel) 2021; 13:cancers13061396. [PMID: 33808614 PMCID: PMC8003397 DOI: 10.3390/cancers13061396] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Bladder cancer is a complex disease, the sixth most common cancer, and one of the most expensive cancers to treat. In the last few decades, there has been a significant decrease in the bladder cancer-related mortality rate, potentially related to decreased smoking prevalence, improvements in diagnosing bladder cancer, and advances in treatment. Those advances in diagnostic tools and therapies and greater understanding of the disease are helping to evolve how bladder cancer is managed. The purpose of this article is to provide a review of bladder cancer pathology, diagnosis, staging, radiologic imaging, and management, and highlight recent developments and research. Abstract Methods: Keyword searches of Medline, PubMed, and the Cochrane Library for manuscripts published in English, and searches of references cited in selected articles to identify additional relevant papers. Abstracts sponsored by various societies including the American Urological Association (AUA), European Association of Urology (EAU), and European Society for Medical Oncology (ESMO) were also searched. Background: Bladder cancer is the sixth most common cancer in the United States, and one of the most expensive in terms of cancer care. The overwhelming majority are urothelial carcinomas, more often non-muscle invasive rather than muscle-invasive. Bladder cancer is usually diagnosed after work up for hematuria. While the workup for gross hematuria remains CT urography and cystoscopy, the workup for microscopic hematuria was recently updated in 2020 by the American Urologic Association with a more risk-based approach. Bladder cancer is confirmed and staged by transurethral resection of bladder tumor. One of the main goals in staging is determining the presence or absence of muscle invasion by tumor which has wide implications in regards to management and prognosis. CT urography is the main imaging technique in the workup of bladder cancer. There is growing interest in advanced imaging techniques such as multiparametric MRI for local staging, as well as standardized imaging and reporting system with the recently created Vesicle Imaging Reporting and Data System (VI-RADS). Therapies for bladder cancer are rapidly evolving with immune checkpoint inhibitors, particularly programmed death ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1) inhibitors, as well as another class of immunotherapy called an antibody-drug conjugate which consists of a cytotoxic drug conjugated to monoclonal antibodies against a specific target. Conclusion: Bladder cancer is a complex disease, and its management is evolving. Advances in therapy, understanding of the disease, and advanced imaging have ushered in a period of rapid change in the care of bladder cancer patients.
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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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16
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Orozco-López AP, Moreno-Mesa D, Saldarriaga-Botero JP, García-Valencia J. Estadificación clínica como factor pronóstico en cáncer de vejiga músculo-invasor. Rev Urol 2021. [DOI: 10.1055/s-0040-1721326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ResumenEl cáncer de vejiga músculo invasor (CV-MI), requiere de una adecuada estadificación clínica y patológica, ya que eso determina las estrategias terapéuticas y el pronóstico de la enfermedad, caracterizada por una alta morbimortalidad. Este articulo tiene como objetivo realizar una revisión de la literatura sobre la exactitud diagnóstica de las técnicas de imagen disponibles para la estadificación clínica de los pacientes con CV-MI y cómo se debería realizar el seguimiento radiológico en los pacientes llevados a cirugía. Para eso se realizó una búsqueda en la base de datos Pubmed de artículos en inglés y en español, se incluyeron artículos de revisión, metanálisis, guías clínicas, estudios retrospectivos y prospectivos de pronóstico y diagnóstico desde el año 1988 hasta el año 2020.
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Affiliation(s)
| | - David Moreno-Mesa
- Residente de urología de la Universidad de Antioquia, Medellín, Colombia
| | | | - Jenny García-Valencia
- Psiquiatra, PhD Epidemiología, docente de la facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Newme K, Hajong R, Bhuyan RK. A clinical study on surgical causes of Hematuria. J Family Med Prim Care 2021; 10:265-271. [PMID: 34017738 PMCID: PMC8132832 DOI: 10.4103/jfmpc.jfmpc_1750_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/27/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Hematuria is a clinical sign and symptom that every individual would have a worst nightmare and invokes a physician to carefully evaluate possible causes of hematuria. It may be medical or surgical causes. A thorough examination is required to exact the primary pathology. As such, a study on hematuria in North east India is not sufficiently researched or published. Material & methods: Here we present an observational study in our institution on that very topic. A study was done purely on surgical causes of hematuria on symptomatic patients. It was done on the inpatient and outpatient basis in Assam Medical College, Dibrugarh during the period of 2016–2019. Total 43 patients were evaluated, who came with symptomatic hematuria. Results: Out of 43 cases of symptomatic hematuria, 34 were male and 9 were females patients. Carcinoma urinary bladder was the commonest cause of hematuria, followed by BPH, urolithiasis, carcinoma prostrate, carcinoma upper urinary tract, etc. Conclusion: Benign prostatic hyperplasia was found to be the most common benign cause and carcinoma bladder was the commonest malignant cause of hematuria.
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Affiliation(s)
| | - Ranendra Hajong
- Associate Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Ratna Kanta Bhuyan
- Professor, Department of General Surgery, Assam Medical College, Dibrugarh, Assam, India
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18
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Allen BC, Oto A, Akin O, Alexander LF, Chong J, Froemming AT, Fulgham PF, Lloyd S, Maranchie JK, Mody RN, Patel BN, Schieda N, Turkbey IB, Vapiwala N, Venkatesan AM, Wang CL, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Post-Treatment Surveillance of Bladder Cancer. J Am Coll Radiol 2020; 16:S417-S427. [PMID: 31685109 DOI: 10.1016/j.jacr.2019.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/25/2022]
Abstract
Urothelial cancer is the second most common cancer, and cause of cancer death, related to the genitourinary tract. The goals of surveillance imaging after the treatment of urothelial cancer of the urinary bladder are to detect new or previously undetected urothelial tumors, to identify metastatic disease, and to evaluate for complications of therapy. For surveillance, patients can be stratified into one of three groups: (1) nonmuscle invasive bladder cancer with no symptoms or additional risk factors; (2) nonmuscle invasive bladder cancer with symptoms or additional risk factors; and (3) muscle invasive bladder cancer. This article is a review of the current literature for urothelial cancer and resulting recommendations for surveillance imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina.
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas, American Urological Association
| | - Shane Lloyd
- Huntsman Cancer Hospital, Salt Lake City, Utah
| | | | | | - Bhavik N Patel
- Stanford University Medical Center, Stanford, California
| | - Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
| | | | - Neha Vapiwala
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Carolyn L Wang
- University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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19
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The Role of Imaging in Bladder Cancer Diagnosis and Staging. Diagnostics (Basel) 2020; 10:diagnostics10090703. [PMID: 32948089 PMCID: PMC7555625 DOI: 10.3390/diagnostics10090703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 01/23/2023] Open
Abstract
Bladder cancer (BC) is the most common cancer of the urinary tract in the United States. Imaging plays a significant role in the management of patients with BC, including the locoregional staging and evaluation for distant metastatic disease, which cannot be assessed at the time of cystoscopy and biopsy/resection. We aim to review the current role of cross-sectional and molecular imaging modalities for the staging and restaging of BC and the potential advantages and limitations of each imaging modality. CT is the most widely available and frequently utilized imaging modality for BC and demonstrates good performance for the detection of nodal and visceral metastatic disease. MRI offers potential value for the locoregional staging and evaluation of muscular invasion of BC, which is critically important for prognostication and treatment decision-making. FDG-PET/MRI is a novel hybrid imaging modality combining the advantages of both MRI and FDG-PET/CT in a single-setting comprehensive staging examination and may represent the future of BC imaging evaluation.
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20
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Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. French ccAFU guidelines – Update 2018–2020: Bladder cancer. Prog Urol 2020; 28:R48-R80. [PMID: 32093463 DOI: 10.1016/j.purol.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/27/2022]
Abstract
Objective To propose updated French guidelines for non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers. Methods A Medline search was achieved between 2015 and 2018, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. Results Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS < 1) and renal function (creatinine clearance > 60 mL/min) allow it (only in 50 % of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. Conclusion These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,GRC no 5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, Sorbonne université, AP–HP, 75013 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’anatomie pathologique, GRC no 5, ONCOTYPE-URO, hôpital Tenon, HUEP, Sorbonne université, AP-HP, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP–HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Département d’oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital Saint-Louis, université Paris-Diderot, AP–HP, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie de l’hôpital Bichat-Claude-Bernard, université Paris-Descartes, AP–HP, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Département d’urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP–HP, 75015 Paris, France
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Eulitt PJ, Altun E, Sheikh A, Wong TZ, Woods ME, Rose TL, Wallen EM, Pruthi RS, Smith AB, Nielsen ME, Whang YE, Kim WY, Godley PA, Basch EM, David GU, Ramirez J, Deal AM, Rathmell WK, Chen RC, Bjurlin MA, Lin W, Lee JK, Milowsky MI. Pilot Study of [ 18F] Fluorodeoxyglucose Positron Emission Tomography (FDG-PET)/Magnetic Resonance Imaging (MRI) for Staging of Muscle-invasive Bladder Cancer (MIBC). Clin Genitourin Cancer 2020; 18:378-386.e1. [PMID: 32147364 DOI: 10.1016/j.clgc.2020.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Computed tomography (CT) has limited diagnostic accuracy for staging of muscle-invasive bladder cancer (MIBC). [18F] Fluorodeoxyglucose positron emission tomography (FDG-PET)/magnetic resonance imaging (MRI) is a novel imaging modality incorporating functional imaging with improved soft tissue characterization. This pilot study evaluated the use of preoperative FDG-PET/MRI for staging of MIBC. PATIENTS AND METHODS Twenty-one patients with MIBC with planned radical cystectomy were enrolled. Two teams of radiologists reviewed FDG-PET/MRI scans to determine: (1) presence of primary bladder tumor; and (2) lymph node involvement and distant metastases. FDG-PET/MRI was compared with cystectomy pathology and computed tomography (CT). RESULTS Eighteen patients were included in the final analysis, most (72.2%) of whom received neoadjuvant chemotherapy. Final pathology revealed 10 (56%) patients with muscle invasion and only 3 (17%) patients with lymph node involvement. Clustered analysis of FDG-PET/MRI radiology team reads revealed a sensitivity of 0.80 and a specificity of 0.56 for detection of the primary tumor with a sensitivity of 0 and a specificity of 1.00 for detection of lymph node involvement when compared with cystectomy pathology. CT imaging demonstrated similar rates in evaluation of the primary tumor (sensitivity, 0.91; specificity, 0.43) and lymph node involvement (sensitivity, 0; specificity, 0.93) when compared with pathology. CONCLUSIONS This pilot single-institution experience of FDG-PET/MRI for preoperative staging of MIBC performed similar to CT for the detection of the primary tumor; however, the determination of lymph node status was limited by few patients with true pathologic lymph node involvement. Further studies are needed to evaluate the potential role for FDG-PET/MRI in the staging of MIBC.
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Affiliation(s)
- Patrick J Eulitt
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ersan Altun
- Division of Abdominal Imaging, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Arif Sheikh
- Division of Nuclear Medicine, Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Terence Z Wong
- Division of Nuclear Medicine, Department of Radiology, Duke University School of Medicine, Durham, NC
| | - Michael E Woods
- Department of Urology, Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | - Tracy L Rose
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Eric M Wallen
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Raj S Pruthi
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Angela B Smith
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Young E Whang
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - William Y Kim
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Paul A Godley
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Ethan M Basch
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Grace U David
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Juanita Ramirez
- Biomedical Research Imaging Center, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - W Kimryn Rathmell
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Weili Lin
- Biomedical Research Imaging Center, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Joseph K Lee
- Division of Abdominal Imaging, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Diagnostic Imaging, National University Hospital of Singapore, Singapore
| | - Matthew I Milowsky
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
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22
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PET/CT in Renal, Bladder, and Testicular Cancer. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Mirmomen SM, Shinagare AB, Williams KE, Silverman SG, Malayeri AA. Preoperative imaging for locoregional staging of bladder cancer. Abdom Radiol (NY) 2019; 44:3843-3857. [PMID: 31377833 DOI: 10.1007/s00261-019-02168-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bladder cancer is the ninth most common cancer, expected to lead to an estimated 17,670 deaths in the United States in 2019. Clinical management and prognosis of bladder cancer mainly depend on the extent of locoregional disease, particularly whether bladder muscle is involved. Therefore, bladder cancer is often divided into superficial, non-muscle-invasive bladder cancer and muscle-invasive bladder cancer; the latter often prompts consideration for cystectomy. While precise staging prior to cystectomy is crucial, the optimal preoperative imaging modality used to stage the disease remains controversial. Transurethral resection of bladder tumor (TURBT) followed by computed tomography (CT) urography is the current recommended approach for staging bladder cancer but suffers from a high rate of understaging. We review the recent literature and compare different imaging modalities for assessing the presence of muscle invasion and lymph node involvement prior to cystectomy and highlight the advantages of each modality.
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24
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Zhu CZ, Ting HN, Ng KH, Ong TA. A review on the accuracy of bladder cancer detection methods. J Cancer 2019; 10:4038-4044. [PMID: 31417648 PMCID: PMC6692607 DOI: 10.7150/jca.28989] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 04/28/2019] [Indexed: 01/01/2023] Open
Abstract
Background and purpose: Bladder cancer is the most common malignant tumour in the urinary system, with a high incidence and recurrence rate. While the incidence of bladder cancer has been rising in recent years, the prevalence of bladder carcinoma is showing an increasing tendency in the younger age group. There are several methods to detect bladder cancer, but different methods have varying degrees of accuracy which intrinsically depends on the method's sensitivity and specificity. Our aim was to comprehensively summarize the current detection methods for bladder cancer based on the available literature, and at the same time, to find the best combination of different effective methods which can produce a high degree of accuracy in detecting the presence of cancerous cells in the bladder. Materials and Methods: We used key word retrieval method for searching related references in English that had been indexed in PubMed and Medline. Results and Discussion: This paper discussed the different detection methods and their sensitivities/specificities as well as the advantages and disadvantages. We summarized the best identified cancer cell detection methods with higher sensitivity/specificity. Conclusion: The results of this review can positively help to identify accurate methods for detecting bladder cancer and highlight areas to be further improved for future research work.
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Affiliation(s)
- Chao-Zhe Zhu
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Hua-Nong Ting
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Kwan-Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Teng-Aik Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
Optical and cross-sectional imaging plays critical roles in bladder cancer diagnostics. White light cystoscopy remains the cornerstone for the management of non-muscle-invasive bladder cancer. In the last decade, significant technological improvements have been introduced for optical imaging to address the known shortcomings of white light cystoscopy. Enhanced cystoscopy modalities such as blue light cystoscopy and narrowband imaging survey a large area of the urothelium and provide contrast enhancement to detect additional lesions and decrease cancer recurrence. However, higher false-positive rates accompany the gain of sensitivity. Optical biopsy technologies, including confocal laser endomicroscopy and optical coherence tomography, provide cellular resolutions combined with subsurface imaging, thereby enabling optical-based cancer characterization, and may lead to real-time cancer grading and staging. Coupling of fluorescently labeled binding agents with optical imaging devices may translate into high molecular specificity, thus enabling visualization and characterization of biological processes at the molecular level. For cross-sectional imaging, upper urinary tract evaluation and assessment potential extravesical tumor extension and metastases are currently the primary roles, particularly for management of muscle-invasive bladder cancer. Multi-parametric MRI, including dynamic gadolinium-enhanced and diffusion-weighted sequences, has been investigated for primary bladder tumor detection. Ultrasmall superparamagnetic particles of iron oxide (USPIO) are a new class of contrast agents that increased the accuracy of lymph node imaging. Combination of multi-parametric MRI with positron emission tomography is on the horizon to improve accuracy rates for primary tumor diagnostics as well as lymph node evaluation. As these high-resolution optical and cross-sectional technologies emerge and develop, judicious assessment and validation await for their clinical integration toward improving the overall management of bladder cancer.
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26
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Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs de la vessie French ccAFU guidelines — Update 2018—2020: Bladder cancer. Prog Urol 2018; 28:S46-S78. [PMID: 30366708 DOI: 10.1016/j.purol.2018.07.283] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.006.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.006.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne université, GRC no5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne université, GRC no5, ONCOTYPE-URO, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude-Bernard, université Paris-Descartes, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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Mesa A, Nava E, Fernández del Valle A, Argüelles B, Menéndez-del Llano R, Sal de Rellán S. Role of imaging techniques in the diagnosis and follow-up of muscle-invasive bladder carcinoma. Actas Urol Esp 2018; 42:425-434. [PMID: 29029769 DOI: 10.1016/j.acuro.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Muscle-invasive bladder malignancies represent 20-30% of all bladder cancers. These patients require imaging tests to determine the regional and distant staging. OBJECTIVE To describe the role of various imaging tests in the diagnosis, staging and follow-up of muscle-invasive bladder cancer. To assess recent developments in radiology aimed at improving the sensitivity and specificity of local staging and treatment response. ACQUISITION OF EVIDENCE We conducted an updated literature review. SYNTHESIS OF THE EVIDENCE Computed tomography and magnetic resonance imaging (MRI) are the tests of choice for performing proper staging prior to surgery. Computed tomography urography is currently the most widely used technique, although it has limitations in local staging. Ultrasonography still has a limited role. Recent developments in MRI have improved its capacity for local staging. MRI has been suggested as the test of choice for the follow-up, with promising results in assessing treatment response. Positron emission tomography could improve the detection of adenopathies and extrapelvic metastatic disease. CONCLUSIONS Imaging tests are essential for the diagnosis, staging and follow-up of muscle-invasive bladder cancer. Recent technical developments represent important improvements in local staging and have opened the possibility of assessing treatment response.
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Raman SP, Fishman EK. Upper and Lower Tract Urothelial Imaging Using Computed Tomography Urography. Urol Clin North Am 2018; 45:389-405. [PMID: 30031461 DOI: 10.1016/j.ucl.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Computed tomography (CT) urography is the best noninvasive method of evaluating the upper urinary tract for urothelial malignancies. However, the utility of CT urography is heavily contingent on the use of proper image acquisition protocols. This article focuses on the appropriate protocols for optimizing CT urography acquisitions, including contrast administration and the timing of imaging acquisitions, as well as the use of ancillary techniques to increase collecting system distention. In addition, imaging findings are discussed that should raise concern for urothelial carcinoma at each of the 3 segments of the urinary tract: the intrarenal collecting systems, ureters, and bladder.
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Affiliation(s)
- Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 North Caroline Street, Baltimore, MD 21287, USA.
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 North Caroline Street, Baltimore, MD 21287, USA
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29
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Trinh TW, Glazer DI, Sadow CA, Sahni VA, Geller NL, Silverman SG. Bladder cancer diagnosis with CT urography: test characteristics and reasons for false-positive and false-negative results. Abdom Radiol (NY) 2018; 43:663-671. [PMID: 28677000 DOI: 10.1007/s00261-017-1249-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine test characteristics of CT urography for detecting bladder cancer in patients with hematuria and those undergoing surveillance, and to analyze reasons for false-positive and false-negative results. METHODS A HIPAA-compliant, IRB-approved retrospective review of reports from 1623 CT urograms between 10/2010 and 12/31/2013 was performed. 710 examinations for hematuria or bladder cancer history were compared to cystoscopy performed within 6 months. Reference standard was surgical pathology or 1-year minimum clinical follow-up. False-positive and false-negative examinations were reviewed to determine reasons for errors. RESULTS Ninety-five bladder cancers were detected. CT urography accuracy: was 91.5% (650/710), sensitivity 86.3% (82/95), specificity 92.4% (568/615), positive predictive value 63.6% (82/129), and negative predictive value was 97.8% (568/581). Of 43 false positives, the majority of interpretation errors were due to benign prostatic hyperplasia (n = 12), trabeculated bladder (n = 9), and treatment changes (n = 8). Other causes include blood clots, mistaken normal anatomy, infectious/inflammatory changes, or had no cystoscopic correlate. Of 13 false negatives, 11 were due to technique, one to a large urinary residual, one to artifact. There were no errors in perception. CONCLUSION CT urography is an accurate test for diagnosing bladder cancer; however, in protocols relying predominantly on excretory phase images, overall sensitivity remains insufficient to obviate cystoscopy. Awareness of bladder cancer mimics may reduce false-positive results. Improvements in CTU technique may reduce false-negative results.
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Affiliation(s)
- Tony W Trinh
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Daniel I Glazer
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Cheryl A Sadow
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - V Anik Sahni
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Nina L Geller
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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30
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Woo S, Cho JY. Bladder Cancer. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Rose TL, Lotan Y. Advancements in optical techniques and imaging in the diagnosis and management of bladder cancer. Urol Oncol 2017; 36:97-102. [PMID: 29288006 DOI: 10.1016/j.urolonc.2017.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/11/2017] [Accepted: 11/18/2017] [Indexed: 11/28/2022]
Abstract
Accurate detection and staging is critical to the appropriate management of urothelial cancer (UC). The use of advanced optical techniques during cystoscopy is becoming more widespread to prevent recurrent nonmuscle invasive bladder cancer. Standard of care for muscle-invasive UC includes the use of computed tomography and/or magnetic resonance imaging, but staging accuracy of these tests remains imperfect. Novel imaging modalities are being developed to improve current test performance. Positron emission tomography/computed tomography has a role in the initial evaluation of select patients with muscle-invasive bladder cancer and in disease recurrence in some cases. Several novel immuno-positron emission tomography tracers are currently in development to address the inadequacy of current imaging modalities for monitoring of tumor response to newer immune-based treatments. This review summaries the current standards and recent advances in optical techniques and imaging modalities in localized and metastatic UC.
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Affiliation(s)
- Tracy L Rose
- Division of Hematology/Oncology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
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32
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Wang F, Jin D, Hua XL, Zhao ZZ, Wu LM, Chen WB, Wu GY, Chen XX, Chen HG. Investigation of diffusion kurtosis imaging for discriminating tumors from inflammatory lesions after treatment for bladder cancer. J Magn Reson Imaging 2017; 48:259-265. [PMID: 29232021 DOI: 10.1002/jmri.25924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/28/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Fang Wang
- Department of Radiology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Di Jin
- Department of Urology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Xiao-Lan Hua
- Department of Radiology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Zi-Zhou Zhao
- Department of Radiology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Lian-Ming Wu
- Department of Radiology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | | | - Guang-Yu Wu
- Department of Radiology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Xiao-Xi Chen
- Department of Radiology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Hai-Ge Chen
- Department of Urology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
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Choe J, Braschi-Amirfarzan M, Tirumani SH, Shinagare AB, Kim KW, Ramaiya NH, Krajewski KM. Updates for the radiologist in non-muscle-invasive, muscle-invasive, and metastatic bladder cancer. Abdom Radiol (NY) 2017; 42:2710-2724. [PMID: 28580540 DOI: 10.1007/s00261-017-1195-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Urothelial bladder cancer is a common malignancy requiring a multidisciplinary approach to treatment. Significant recent advances have been made in terms of the genetic and molecular characterization of bladder cancer subtypes, and novel treatment approaches are being investigated and approved. Given the important role of imaging in the diagnosis, staging, and follow-up of this disease, it is necessary for radiologists to remain up-to-date in terms of nomenclature and standards of care. In this review, recent developments in bladder cancer characterization and treatment will be discussed, with reference to the contributions of imaging in non-muscle-invasive, muscle-invasive, and metastatic settings.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Marta Braschi-Amirfarzan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Sree Harsha Tirumani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Atul B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Nikhil H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Katherine M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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34
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Bladder Cancer Treatment Response Assessment in CT using Radiomics with Deep-Learning. Sci Rep 2017; 7:8738. [PMID: 28821822 PMCID: PMC5562694 DOI: 10.1038/s41598-017-09315-w] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 07/18/2017] [Indexed: 02/06/2023] Open
Abstract
Cross-sectional X-ray imaging has become the standard for staging most solid organ malignancies. However, for some malignancies such as urinary bladder cancer, the ability to accurately assess local extent of the disease and understand response to systemic chemotherapy is limited with current imaging approaches. In this study, we explored the feasibility that radiomics-based predictive models using pre- and post-treatment computed tomography (CT) images might be able to distinguish between bladder cancers with and without complete chemotherapy responses. We assessed three unique radiomics-based predictive models, each of which employed different fundamental design principles ranging from a pattern recognition method via deep-learning convolution neural network (DL-CNN), to a more deterministic radiomics feature-based approach and then a bridging method between the two, utilizing a system which extracts radiomics features from the image patterns. Our study indicates that the computerized assessment using radiomics information from the pre- and post-treatment CT of bladder cancer patients has the potential to assist in assessment of treatment response.
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Abstract
PURPOSE To determine the accuracy of split-bolus CT urogram (SB-CTU) without special maneuvers for ureteral distention in diagnosing upper urinary tract urothelial carcinoma (UCA). MATERIALS AND METHODS A hospital database was searched from 1/1/10, to 9/1/15, for SB-CTU exams without special maneuvers for ureteral distention. Accuracy of SB-CTU for detecting upper and lower urinary tract UCA was computed by comparing the prospective radiology report with cystoscopy, ureteroscopy, and/or urologic clinical follow-up. Patients with less than 12 months of clinical follow-up were excluded. RESULTS 339 studies were identified in 334 patients (60% male 40% female, avg. age 64). 119 studies were performed for microhematuria, 150 for gross hematuria, 13 for hematuria not otherwise specified, 57 for history of UCA, and one for a collecting system mass on a prior CT. There were five upper tract and 33 bladder tumors with overall prevalence of 1.5% and 9.7%, respectively. The prevalence varied significantly with patient age and clinical indication for SB-CTU. There were one false negative and four false positives for upper urinary tract UCA. Sensitivity, specificity, positive predictive value, and negative predictive value for detecting upper tract and bladder tumors were 80%, 99%, 44%, and 100%, respectively, and 55%, 98%, 78%, and 95%, respectively. CONCLUSION Based on this study, SB-CTU without special maneuvers for ureteral distention is highly sensitive for detecting upper tract UCA, although with a low positive predictive value, false positives do occur. The clinical utility of increasing accuracy in diagnosing this low-prevalence disease through other more complex CT urogram protocols should be weighed against the added cost and radiation dose associated with these protocols.
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36
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Bagheri MH, Ahlman MA, Lindenberg L, Turkbey B, Lin J, Cahid Civelek A, Malayeri AA, Agarwal PK, Choyke PL, Folio LR, Apolo AB. Advances in medical imaging for the diagnosis and management of common genitourinary cancers. Urol Oncol 2017; 35:473-491. [PMID: 28506596 PMCID: PMC5931389 DOI: 10.1016/j.urolonc.2017.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 01/01/2023]
Abstract
Medical imaging of the 3 most common genitourinary (GU) cancers-prostate adenocarcinoma, renal cell carcinoma, and urothelial carcinoma of the bladder-has evolved significantly during the last decades. The most commonly used imaging modalities for the diagnosis, staging, and follow-up of GU cancers are computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET). Multiplanar multidetector computed tomography and multiparametric MRI with diffusion-weighted imaging are the main imaging modalities for renal cell carcinoma and urothelial carcinoma, and although multiparametric MRI is rapidly becoming the main imaging tool in the evaluation of prostate adenocarcinoma, biopsy is still required for diagnosis. Functional and molecular imaging using 18-fluorodeoxyglucose-PET and sodium fluoride-PET are essential for the diagnosis, and especially follow-up, of metastatic GU tumors. This review provides an overview of the latest advances in the imaging of these 3 major GU cancers.
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Affiliation(s)
- Mohammad H Bagheri
- Clinical Image Processing Service, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Mark A Ahlman
- Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jeffrey Lin
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ali Cahid Civelek
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Piyush K Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Les R Folio
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Halpern JA, Chughtai B, Ghomrawi H. Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria. JAMA Intern Med 2017; 177:800-807. [PMID: 28418451 PMCID: PMC5818826 DOI: 10.1001/jamainternmed.2017.0739] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignant abnormality. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignant abnormality among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. OBJECTIVE To estimate the effectiveness, costs, and incremental cost per cancer detected (ICCD) for 4 common diagnostic approaches evaluating AMH. DESIGN, SETTING, AND PARTICIPANTS A decision-analytic model-based cost-effectiveness analysis using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included adult patients with AMH on routine urinalysis with subgroups of high-risk patients (males, smokers, age ≥50 years) seen in the primary care or urologic referral setting. INTERVENTIONS Four diagnostic approaches were evaluated relative to the reference case of no evaluation: (1) computed tomography (CT) alone; (2) cystoscopy alone; (3) CT and cystoscopy combined; and (4) renal ultrasound and cystoscopy combined. MAIN OUTCOMES AND MEASURES At termination of the diagnostic period, cancers detected, costs (payer perspective), and ICCD per 10 000 patients evaluated for AMH. RESULTS Of the 4 diagnostic approaches analyzed, CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9 300 000. Ultrasound and cystoscopy detected 245 cancers and was most cost-effective with an ICCD of $53 810. Replacing ultrasound with CT detected just 1 additional cancer at an ICCD of $6 480 484. Ultrasound and cystoscopy remained the most cost-effective approach in subgroup analysis. The model was not sensitive to any inputs within the proposed ranges. Using probabilistic sensitivity analysis, ultrasound and cystoscopy was the dominant strategy in 100% of simulations. CONCLUSIONS AND RELEVANCE The combination of renal ultrasound and cystoscopy is the most cost-effective among 4 diagnostic approaches for the initial evaluation of AMH. The use of ultrasound in lieu of CT as the first-line diagnostic strategy will optimize cancer detection and reduce costs associated with evaluation of AMH. Given our findings, we need to critically evaluate the appropriateness of our current clinical practices, and potentially alter our guidelines to reflect the most effective screening strategies for patients with AMH.
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Affiliation(s)
- Joshua A Halpern
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Hassan Ghomrawi
- Departments of Surgery and Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Upper and Lower Tract Urothelial Imaging Using Computed Tomography Urography. Radiol Clin North Am 2017; 55:225-241. [DOI: 10.1016/j.rcl.2016.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Prospective Pilot Study to Evaluate the Incremental Value of PET Information in Patients With Bladder Cancer Undergoing 18F-FDG Simultaneous PET/MRI. Clin Nucl Med 2017; 42:e8-e15. [PMID: 27775939 DOI: 10.1097/rlu.0000000000001432] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to conduct a prospective pilot study comparing the diagnostic performance of MRI alone and F-FDG simultaneous PET/MRI using a diuresis protocol in bladder cancer patients. METHODS Twenty-two bladder cancer patients underwent F-FDG PET/MRI, using intravenous furosemide and oral hydration for bladder clearance. A radiologist scored probability of tumor in 3 locations (urinary bladder, pelvic lymph nodes, nonnodal pelvis) using 1- to 3-point scale (1 = negative, 2 = equivocal, 3 = definite tumor). A nuclear medicine physician reviewed fused PET/MRI images, after which scores were reassigned based on combined findings. Follow-up pathologic and imaging data served as reference. Performances of MRI alone and PET/MRI were compared. RESULTS Of these patients, 82%, 38%, and 18% were positive for bladder, pelvic nodal, and nonnodal pelvic tumor, respectively. At a score of 3, PET/MRI exhibited greater accuracy for detection of bladder tumor (86% vs 77%), metastatic pelvic lymph nodes (95% vs 76%), and nonnodal pelvic malignancy (100% vs 91%). In the bladder, PET changed the level of suspicion in 36% of patients (50% increased suspicion, 50% decreased suspicion), with 75% of these changes deemed correct based on reference standard. For pelvic lymph nodes, PET changed suspicion in 52% (36% increase, 64% decrease), with 95% of changes deemed correct. For nonnodal pelvis, PET changed suspicion in 9% (100% increase), with 100% deemed correct. CONCLUSIONS Additional PET information helped to appropriately determine level of suspicion in multiple anatomic sites for otherwise equivocal findings on MRI alone. Although requiring larger studies, findings suggest a possible role for simultaneous PET/MRI to assist bladder cancer management.
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Clinical significance of incidentally detected bladder wall thickening on computed tomography. Int Urol Nephrol 2016; 49:191-196. [PMID: 27888433 DOI: 10.1007/s11255-016-1458-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the clinical significance of incidentally detected bladder wall thickening (BWT) on computed tomography (CT). METHODS A retrospective analysis was performed on 34,793 cystoscopy cases between January 2004 and December 2013. Among these, patients who underwent cystoscopy for the sole indication of incidentally detected BWT on CT were selected. Patients were categorized into the diffuse or focal group depending on the extent of BWT. Suspicious lesions on cystoscopy were biopsied to confirm histologic subtype. The incidence and predictive factors of bladder malignancy were examined. RESULTS A total of 167 (0.5%) patients received cystoscopy for incidentally detected BWT on CT, of which 11 (6.6%) patients were diagnosed with bladder malignancy. When a suspicious lesion was identified on cystoscopy, 11 of 25 (44%) patients were found to have a bladder malignancy. Of the 15 patients with diffuse BWT, 5 (33.3%) were diagnosed with bladder malignancy, consisting of carcinoma in situ in 2 patients, high-grade carcinoma in 2 patients and muscle invasive disease in 1 patient. Of the 10 patients with focal BWT, 6 (60.0%) were diagnosed with bladder malignancy, of which 3 patients had high-grade disease. On multivariate logistic regression analysis, focal BWT [95% confidence interval (CI) 1.400-25.357, P = 0.016] and atypical cells in urine cytology (95% CI 2.631-63.446, P = 0.002) were positively associated with bladder malignancy. CONCLUSIONS Incidentally detected BWT on CT can be suggestive of bladder malignancy. Therefore, further work-up including cystoscopy and urine cytology should be performed to assess bladder malignancy.
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Page L, Wei W, Kundra V, Rong XJ. Dose reduction in CT urography and vasculature phantom studies using model-based iterative reconstruction. J Appl Clin Med Phys 2016; 17:334-342. [PMID: 27929506 PMCID: PMC5690497 DOI: 10.1120/jacmp.v17i6.6184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 06/22/2016] [Accepted: 06/21/2016] [Indexed: 11/23/2022] Open
Abstract
To evaluate the feasibility of radiation dose reduction using model-based iterative reconstruction (MBIR) for evaluating the ureters and vasculature in a phantom, a tissue-equivalent CT dose phantom was scanned using a 64-channel CT scan-ner. Tubes of varying diameters filled with different dilutions of a contrast agent, simulating ureters or vessels, were inserted into the center of the phantom. Each combination was scanned using an existing renal protocol at 140 kVp or 120 kVp, yielding a display volumetric CT dose index (CTDIvol) of 24 mGy. The scans were repeated using reduced scan techniques to achieve lower radiation doses down to 0.8 mGy. The images were reconstructed using filtered back-projection (FBP) and model-based iterative reconstruction (MBIR). The noise and contrast-to-noise ratio (CNR) was measured for each contrast object. Comparisons between the two reconstruction methods at different dose levels were evaluated using a factorial design. At each CTDIvol the measured image noise was lower using MBIR compared to FBP (p < 0.0001). At low doses, the percent change in measured image noise between FBP and MBIR was larger. For the 12 mm object simulating a ureter or large vessel with an HU of 600, the measured CNR using MBIR at a CTDIvol of 1.7 mGy was greater than the CNR of FBP at a CTIDvol of 24 mGy (p < 0.0001). For the 5 mm object simulating a medium-sized vessel with a HU of 250, the mea-sured CNR using MBIR at a CTDIvol of 1.7 mGy was equivalent to that of FBP at a CTDIvol of 24 mGy. For the 2 mm, 100 HU object simulating a small vessel, the measured CNR using MBIR at a CTDIvol of 1.7 mGy was equivalent to that of FBP at a CTDIvol of 24 mGy. Low-dose (3.6 mGy) CT imaging of vasculature and ureter phantoms using MBIR results in similar noise and CNR compared to FBP at approximately one-sixth the dose. This suggests that, using MBIR, a one milliSievert exam of the ureters and vasculature may be clinically possible whilst still maintaining adequate image quality.
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Affiliation(s)
- Leland Page
- The University of Texas MD Anderson Cancer Center.
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Non-invasive quantification of tumour heterogeneity in water diffusivity to differentiate malignant from benign tissues of urinary bladder: a phase I study. Eur Radiol 2016; 27:2146-2152. [PMID: 27553924 DOI: 10.1007/s00330-016-4549-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To quantify the heterogeneity of the tumour apparent diffusion coefficient (ADC) using voxel-based analysis to differentiate malignancy from benign wall thickening of the urinary bladder. METHODS Nineteen patients with histopathological findings of their cystectomy specimen were included. A data set of voxel-based ADC values was acquired for each patient's lesion. Histogram analysis was performed on each data set to calculate uniformity (U) and entropy (E). The k-means clustering of the voxel-wised ADC data set was implemented to measure mean intra-cluster distance (MICD) and largest inter-cluster distance (LICD). Subsequently, U, E, MICD, and LICD for malignant tumours were compared with those for benign lesions using a two-sample t-test. RESULTS Eleven patients had pathological confirmation of malignancy and eight with benign wall thickening. Histogram analysis showed that malignant tumours had a significantly higher degree of ADC heterogeneity with lower U (P = 0.016) and higher E (P = 0.005) than benign lesions. In agreement with these findings, k-means clustering of voxel-wise ADC indicated that bladder malignancy presented with significantly higher MICD (P < 0.001) and higher LICD (P = 0.002) than benign wall thickening. CONCLUSIONS The quantitative assessment of tumour diffusion heterogeneity using voxel-based ADC analysis has the potential to become a non-invasive tool to distinguish malignant from benign tissues of urinary bladder cancer. KEY POINTS • Heterogeneity is an intrinsic characteristic of tumoral tissue. • Non-invasive quantification of tumour heterogeneity can provide adjunctive information to improve cancer diagnosis accuracy. • Histogram analysis and k-means clustering can quantify tumour diffusion heterogeneity. • The quantification helps differentiate malignant from benign urinary bladder tissue.
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Otis JB, Zong H, Kotylar A, Yin A, Bhattacharjee S, Wang H, James R. B, Wang SH. Dendrimer antibody conjugate to target and image HER-2 overexpressing cancer cells. Oncotarget 2016; 7:36002-36013. [PMID: 27144519 PMCID: PMC5094978 DOI: 10.18632/oncotarget.9081] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/31/2016] [Indexed: 12/25/2022] Open
Abstract
Although many breast and lung cancers overexpress human epidermal growth factor receptor-2 (HER-2), no methods currently exist for effective and early detection of HER-2-positive cancers. To address this issue, we designed and synthesized dendrimer-based novel nano-imaging agents that contain gold nanoparticles (AuNPs) and gadolinium (Gd), conjugated with the humanized anti-HER-2 antibody (Herceptin). Generation 5 (G5) polyamidoamine (PAMAM) dendrimers were selected as the backbone for the nano-imaging agents due to their unique size, high ratio of surface functional groups and bio-functionality. We modified G5 PAMAM dendrimer surface with PEG and 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) chelators to encapsulate AuNPs and complex Gd. These dendrimer entrapped AuNPs were further conjugated with Herceptin through copper-catalyzed azide- alkyne click reaction to construct the nano-imaging agent Au-G5-Gd-Herceptin. The targeted nano-imaging agent bound selectively to HER-2 overexpressing cell lines, with subsequent internalization into the cells. More importantly, non-targeted nano-imaging agent neither bound nor internalized into cells overexpressing HER-2. These results suggest that our approach could provide a platform to develop nano-diagnostic agents or nano-therapeutic agents for early detection and treatment of HER-2-positive cancers.
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Affiliation(s)
- James B. Otis
- Department of Internal Medicine, Division of Allergy, Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Hong Zong
- Department of Internal Medicine, Division of Allergy, Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Alina Kotylar
- Department of Internal Medicine, Division of Allergy, Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna Yin
- Department of Internal Medicine, Division of Allergy, Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Somnath Bhattacharjee
- Department of Internal Medicine, Division of Allergy, Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Han Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shangai, P.R.China
| | - Baker James R.
- Department of Internal Medicine, Division of Allergy, Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Su He Wang
- Department of Internal Medicine, Division of Allergy, Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
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Comparison of Coregistration Accuracy of Pelvic Structures Between Sequential and Simultaneous Imaging During Hybrid PET/MRI in Patients with Bladder Cancer. Clin Nucl Med 2016; 40:637-41. [PMID: 25783514 DOI: 10.1097/rlu.0000000000000772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of this study was to compare coregistration of the bladder wall, bladder masses, and pelvic lymph nodes between sequential and simultaneous PET and MRI acquisitions obtained during hybrid (18)F-FDG PET/MRI performed using a diuresis protocol in bladder cancer patients. METHODS Six bladder cancer patients underwent (18)F-FDG hybrid PET/MRI, including IV Lasix administration and oral hydration, before imaging to achieve bladder clearance. Axial T2-weighted imaging (T2WI) was obtained approximately 40 minutes before PET ("sequential") and concurrently with PET ("simultaneous"). Three-dimensional spatial coordinates of the bladder wall, bladder masses, and pelvic lymph nodes were recorded for PET and T2WI. Distances between these locations on PET and T2WI sequences were computed and used to compare in-plane (x-y plane) and through-plane (z-axis) misregistration relative to PET between T2WI acquisitions. RESULTS The bladder increased in volume between T2WI acquisitions (sequential, 176 [139] mL; simultaneous, 255 [146] mL). Four patients exhibited a bladder mass, all with increased activity (SUV, 9.5-38.4). Seven pelvic lymph nodes in 4 patients showed increased activity (SUV, 2.2-9.9). The bladder wall exhibited substantially less misregistration relative to PET for simultaneous, compared with sequential, acquisitions in in-plane (2.8 [3.1] mm vs 7.4 [9.1] mm) and through-plane (1.7 [2.2] mm vs 5.7 [9.6] mm) dimensions. Bladder masses exhibited slightly decreased misregistration for simultaneous, compared with sequential, acquisitions in in-plane (2.2 [1.4] mm vs 2.6 [1.9] mm) and through-plane (0.0 [0.0] mm vs 0.3 [0.8] mm) dimensions. FDG-avid lymph nodes exhibited slightly decreased in-plane misregistration (1.1 [0.8] mm vs 2.5 [0.6] mm), although identical through-plane misregistration (4.0 [1.9] mm vs 4.0 [2.8] mm). CONCLUSIONS Using hybrid PET/MRI, simultaneous imaging substantially improved bladder wall coregistration and slightly improved coregistration of bladder masses and pelvic lymph nodes.
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Jinzaki M, Kikuchi E, Akita H, Sugiura H, Shinmoto H, Oya M. Role of computed tomography urography in the clinical evaluation of upper tract urothelial carcinoma. Int J Urol 2016; 23:284-98. [DOI: 10.1111/iju.13032] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/15/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Eiji Kikuchi
- Department of Urology; Keio University School of Medicine; Tokyo Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Hiroaki Sugiura
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Hiroshi Shinmoto
- Department of Radiology; National Defense Medical College; Tokorozawa Saitama Japan
| | - Mototsugu Oya
- Department of Urology; Keio University School of Medicine; Tokyo Japan
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Investigation of Multisequence Magnetic Resonance Imaging for Detection of Recurrent Tumor After Transurethral Resection for Bladder Cancer. J Comput Assist Tomogr 2016; 40:201-5. [DOI: 10.1097/rct.0000000000000363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Juri H, Tsuboyama T, Kumano S, Inada Y, Koyama M, Azuma H, Narumi Y. Detection of bladder cancer: comparison of low-dose scans with AIDR 3D and routine-dose scans with FBP on the excretory phase in CT urography. Br J Radiol 2015; 89:20150495. [PMID: 26642306 DOI: 10.1259/bjr.20150495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To prospectively compare the detection of bladder cancer between low-dose scans with adaptive iterative dose reduction three dimensional projection (AIDR 3D) and routine-dose scans with filtered back projection (FBP) on the excretory phase (EP) in CT urography. METHODS 42 patients were included. Routine- and low-dose EP were performed in each patient. Routine-dose images were reconstructed with FBP, and low-dose images were reconstructed with AIDR 3D. Two radiologists scored confidence levels for the presence or absence of bladder cancer using a 5-point scale. The CT dose index of each EP was measured, and the dose reduction was calculated. RESULTS Sensitivity, specificity and accuracy were 86.4%, 95.0% and 90.5% on routine-dose scans and were 86.4%, 90.0% and 88.1% on low-dose scans, respectively. There was no significant difference (p; not significant, 1.00 and 1.00, respectively). The average CT dose index was 8.07 and 2.63 mGy on routine- and low-dose scans, and the ratio of dose reduction was 67.6%. CONCLUSION The detection of bladder cancer on low-dose scans with AIDR 3D is almost equal to that on routine-dose scans with FBP on the EP, with nearly 70% dose reduction. ADVANCES IN KNOWLEDGE Using AIDR 3D, the radiation dose may be reduced on the EP in CT urography for the detection of bladder cancer.
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Affiliation(s)
- Hiroshi Juri
- 1 Department of Radiology, Osaka Medical College, Takatsuki, Japan
| | - Takahiro Tsuboyama
- 2 Department of Radiology, Osaka University School of Medicine, Suita, Japan
| | - Seishi Kumano
- 3 Department of Radiology, Kinki University School of Medicine, Osaka-Sayama, Japan
| | - Yuki Inada
- 1 Department of Radiology, Osaka Medical College, Takatsuki, Japan
| | - Mitsuhiro Koyama
- 1 Department of Radiology, Osaka Medical College, Takatsuki, Japan
| | - Haruhito Azuma
- 4 Department of Urology, Osaka Medical College, Takatsuki, Japan
| | - Yoshifumi Narumi
- 1 Department of Radiology, Osaka Medical College, Takatsuki, Japan
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Kassouf W, Traboulsi SL, Kulkarni GS, Breau RH, Zlotta A, Fairey A, So A, Lacombe L, Rendon R, Aprikian AG, Siemens DR, Izawa JI, Black P. CUA guidelines on the management of non-muscle invasive bladder cancer. Can Urol Assoc J 2015; 9:E690-704. [PMID: 26664503 DOI: 10.5489/cuaj.3320] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | | | | | - Andrew Fairey
- Division of Urology, University of Alberta, Edmonton, AB
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | | | | | | | | | | | - Peter Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Helenius M, Dahlman P, Lonnemark M, Brekkan E, Wernroth L, Magnusson A. Comparison of post contrast CT urography phases in bladder cancer detection. Eur Radiol 2015; 26:585-91. [PMID: 26002135 DOI: 10.1007/s00330-015-3844-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/19/2015] [Accepted: 05/11/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate which post-contrast phase(s) in a four-phase CT urography protocol is (are) most suitable for bladder cancer detection. METHODS The medical records of 106 patients with visible haematuria who underwent a CT urography examination, including unenhanced, enhancement-triggered corticomedullary (CMP), nephrographic (NP) and excretory (EP) phases, were reviewed. The post-contrast phases (n = 318 different phases) were randomized into an evaluation order and blindly reviewed by two uroradiologists. RESULTS Twenty-one patients were diagnosed with bladder cancer. Sensitivity for bladder cancer detection was 0.95 in CMP, 0.83 in NP and 0.81 in EP. Negative predictive value (NPV) was 0.99 in CMP, 0.96 in NP and 0.95 in EP. The sensitivity was higher in CMP than in both NP (p-value 0.016) and EP (p-value 0.0003). NPV was higher in CMP than in NP (p-value 0.024) and EP (p-value 0.002). CONCLUSIONS In the CT urography protocol with enhancement-triggered scan, sensitivity and NPV were highest in the corticomedullary phase, and this phase should be used for bladder assessment. KEY POINTS • More bladder tumours are detected during the corticomedullary phase than during other phases. • Sensitivity and NPV for bladder cancer detection were highest in corticomedullary phase. • The corticomedullary phase in CT urography should be used for bladder assessment.
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Affiliation(s)
- Malin Helenius
- Department of Surgical Sciences, Section of Radiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
| | - Par Dahlman
- Department of Surgical Sciences, Section of Radiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Maria Lonnemark
- Department of Surgical Sciences, Section of Radiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Einar Brekkan
- Department of Surgical Sciences, Section of Urology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Lisa Wernroth
- Uppsala Clinical Research Center, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anders Magnusson
- Department of Surgical Sciences, Section of Radiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
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Horsburgh BA, Belfield J, Lynch C. Precision of computed tomography urography in diagnosing transitional cell carcinoma. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415814551380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Computed tomography urography (CTU) has largely replaced excretion urography. Indications for CTU include patients with haematuria and for upper tract surveillance in those with known transitional cell carcinoma (TCC). Reporting of a possible TCC can lead to complex clinical decisions regarding further investigation and management. The aim of this study is to ascertain the positive predictive value (PPV) of such reports in a large tertiary centre. Methods: Examinations performed from January 2010 to August 2012 were retrospectively identified. Subsequent diagnosis of TCC was confirmed by histology, cytology or accepted by uro-oncology MDT with absence of histological proof. The PPV of reported TCCs was calculated overall, by tumour site and presentation. Results: A total of 1199 CTU investigations were performed. Analysis revealed the PPV of a reported TCC was 67% for kidney, 44% for ureteric and 85% for bladder lesions. Overall PPV was 68% and 51% for the upper tracts. In patients who attended the haematuria clinic, the PPV was 82% and 88% when positive cytology was included. Conclusion: CTU is an appropriate replacement for excretion urography. However, prompt invasive assessment of the entire urinary tract still remains necessary to confirm a suspected TCC.
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Affiliation(s)
| | - J Belfield
- Department of Radiology, the Royal Liverpool and Broadgreen University Hospital NHS Trust, UK
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