A Potential Application of Dynamic Contrast-Enhanced Magnetic Resonance Imaging Combined with Photodynamic Diagnosis for the Detection of Bladder Carcinoma in Situ: Toward the Future 'MRI-PDD Fusion TURBT'.

Tomomi Fujii,Shunta Hori,Fumisato Maesaka,Kiyohide Fujimoto,Nobumichi Tanaka,Tatsuki Miyamoto,Nagaaki Marugami,Yasushi Nakai,Takeshi Inoue,Daisuke Gotoh,Yosuke Morizawa,Makito Miyake,Keiji Shimada,Satoshi Anai,Sayuri Ohnishi,Takuya Owari,Yoshitaka Itami,Kazumasa Torimoto

doi:10.3390/diagnostics9030112

Tomomi Fujii, Shunta Hori + Show 16 more

Open Access

https://doi.org/10.3390/diagnostics9030112

Copy DOI

Journal: Diagnostics (Basel, Switzerland)	Publication Date: Sep 4, 2019
Citations: 4	License type: CC BY 4.0

Affiliation: Nara Medical University

Abstract

The detection of carcinoma in situ (CIS) is essential for the management of high-risk non-muscle invasive bladder cancers. Here, we focused on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with photodynamic diagnosis (PDD) for the detection of CIS. A total of 45 patients undergoing pre-surgical DCE-MRI and PDD-assisted endoscopic surgery accompanied by biopsies of the eight segmentations were analyzed. Immunohistochemical analysis of the biopsies revealed hypervascularity of CIS lesions, a cause of strong submucosal contrast-enhancement. It was found that 56 (16.2%) of 344 biopsies had pathologically proven CIS. In the DCE-MRI, the overall sensitivity and specificity for detecting CIS were 48.2% and 81.9%, respectively. We set out two different combinations of PDD and DCE-MRI for detecting CIS. Combination 1 was positive when either the PDD or DCE-MRI were test-positive. Combination 2 was positive only when both PDD and DCE-MRI were test-positive. The overall sensitivity of combinations 1 and 2 were 75.0% and 37.5%, respectively (McNemar test, vs PDD alone; p = 0.041 and p < 0.001, respectively). However, the specificity was 74.0% and 91.7%, respectively (vs PDD alone; both p < 0.001). Our future goal is to establish ‘MRI-PDD fusion transurethral resction of the bladder tumor (TURBT), which could be an effective therapeutic and diagnostic approach in the clinical management of high-risk disease.

Highlights

Bladder cancer (BCa) is one of the most common malignancies in both male and female patients, with approximately 430,000 new cases diagnosed annually worldwide [1]
75% of the patients treated by transurethral resection of the bladder tumor (TURBT) present with non-muscle invasive bladder cancer (NMIBC) [2,3]
Photodynamic diagnosis (PDD) with fluorescent cystoscopy using an excitation wavelength of 405 nm is performed after administration of 5-aminolevulinic acid (ALA)

Summary

Introduction

Bladder cancer (BCa) is one of the most common malignancies in both male and female patients, with approximately 430,000 new cases diagnosed annually worldwide [1]. 75% of the patients treated by transurethral resection of the bladder tumor (TURBT) present with non-muscle invasive bladder cancer (NMIBC) [2,3]. Diagnostics 2019, 9, 112 the detection and clinical management of high-risk NMIBC, especially of carcinoma in situ (CIS), is still challenging and problematic [4,5]. Because CIS is not curable by an endoscopic surgery alone, diagnosis of CIS must be followed by further treatment, either intravesical administration of Bacillus Calmette-Guérin (BCG) or radical cystectomy. About half of the patients with CIS will progress to muscle-invasive disease [9]. The sensitive and early detection of CIS is essential for adequate management of the high-risk subset. Endoscopic detection technologies have been developed to visualize small tumors and flat lesions including CIS. Photodynamic diagnosis (PDD) with fluorescent cystoscopy using an excitation wavelength of 405 nm is performed after administration of 5-aminolevulinic acid (ALA)

Methods

Results

Discussion

Conclusion