Abstract
Background: Several studies have investigated the potential role of the apparent diffusion coefficient (ADC) value of diffusion-weighted magnetic resonance imaging as a biomarker of high-grade and invasive bladder cancer. Methods: PubMed and the Cochrane Library were systematically searched in September 2021 to extract studies that evaluated the associations between ADC values, pathological T stage, and histological grade bladder cancers. The diagnostic performance of ADC values in detecting muscle-invasive bladder cancer (MIBC) and high-grade disease was systematically reviewed. Results: Six studies were included in this systematic review. MIBC showed significantly lower ADC values than non-muscle-invasive bladder cancer (NMIBC) in all six studies. The median (range) sensitivity, specificity, and area under the curve (AUC) of ADC values to detect MIBC among the four eligible studies were 73.5% (68.8–90.0%), 79.9% (66.7–84.4%), and 0.762 (0.730–0.884), respectively. Similarly, high-grade disease showed significantly lower ADC values than did low-grade disease in all four eligible studies. The median (range) sensitivity, specificity, and AUC of ADC values for detecting high-grade disease among the three eligible studies were 75.0% (73.0–76.5%), 95.8% (76.2–100%), and 0.902 (0.804–0.906), respectively. Conclusions: The ADC value is a non-invasive diagnostic biomarker for discriminating muscle-invasive and high-grade bladder cancer.
Highlights
Bladder cancer is the most common malignancy of the urinary tract
70% of bladder cancer cases are classified as non-muscle-invasive bladder cancer (NMIBC, tumor with T1 or a lower stage) [1]
Patients with high-grade NMIBC and muscle-invasive bladder cancer (MIBC, tumor with T2 or a higher stage) require more intensive therapies, and according to the European Association of Urology guidelines [2], those with high-grade NMIBC are recommended to undergo re-TURBT to rule out possible MIBC or residual disease, followed by intravesical Bacillus Calmette– Guérin instillation because of the high risk of recurrence and progression
Summary
Bladder cancer is the most common malignancy of the urinary tract. Approximately70% of bladder cancer cases are classified as non-muscle-invasive bladder cancer (NMIBC, tumor with T1 or a lower stage) [1]. Patients with high-grade NMIBC and muscle-invasive bladder cancer (MIBC, tumor with T2 or a higher stage) require more intensive therapies, and according to the European Association of Urology guidelines [2], those with high-grade NMIBC are recommended to undergo re-TURBT to rule out possible MIBC or residual disease, followed by intravesical Bacillus Calmette– Guérin instillation because of the high risk of recurrence and progression. The standard of care for patients with non-metastatic MIBC is radical cystectomy with perioperative systemic chemotherapy [3] Despite intensive therapies, these patients are at a high risk of recurrence or metastasis, with a 5-year overall survival rate of approximately 50% [4,5]. The diagnostic performance of ADC values in detecting muscle-invasive bladder cancer (MIBC) and high-grade disease was systematically reviewed. MIBC showed significantly lower ADC values than non-muscle-invasive bladder cancer (NMIBC) in all six studies. Conclusions: The ADC value is a non-invasive diagnostic biomarker for discriminating muscle-invasive and high-grade bladder cancer
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