Evaluation Of Bladder Tumors Research Articles

The role of ultrasound in diagnosis and evaluation of bladder tumors.

Introduction:Bladder tumors are common and the only way to prove it is cystoscopy which is invasive and expensive. Finding noninvasive, well-accepted, and cost-effective method for early detection of bladder cancer is necessary. The aim of this study was to evaluate the role of ultrasonography in the diagnosis and evaluation of bladder tumors.Methods:This study was conducted on 75 patients with indications for cystoscopy. After recording demographic data, ultrasound, and cystoscopy was performed for all patients. Sensitivity and specificity of sonography in the diagnosis of bladder tumors were measured.Results:The most common form of bladder in ultrasound was papillary tumors (86%) and the lowest was related to cystic mass (4%). The sensitivity, specificity, positive predictive value, and negative predictive value of sonography for the diagnosis of bladder tumors were 93.24%, 100%, 100%, and 16.66%, respectively.Conclusion:The results of our study showed that ultrasonography has high sensitivity and specificity in the diagnosis of bladder cancer and since that ultrasound is a noninvasive, well-accepted, and cost-effective diagnostic technique, ultrasound can be performed in suspected patients in the first stage.

Optical Coherence Tomography as an Adjunct to White Light Cystoscopy for Intravesical Real-Time Imaging and Staging of Bladder Cancer

Optical coherence tomography (OCT) is a novel, real-time endoscopic imaging modality that permits delineation of microarchitectural features of bladder lesions. It may provide an extension of conventional cystoscopy by allowing noninvasive examination of bladder tissue at microscopic resolution (10 to 20 microm). The purpose of this study was to examine the application of OCT in augmenting the diagnosis and staging of bladder lesions. We conducted a retrospective institutional review board-approved, single-institution, single-user review on the use of OCT as an adjunct to conventional cystoscopy in 32 patients with a history of bladder cancer (24), primary tumor (6), prostate cancer (1), or hematuria (1). We obtained OCT images of suspicious areas before biopsy or resection, interpreted them in real time, and subsequently compared them with pathology results. We obtained 94 images in 32 patients undergoing bladder biopsy or transurethral resection of bladder tumor. Age of the patients ranged from 49 to 84 years (mean, 59 years), with 25 men (78%) and 7 women (22%). We correlated 38 suspicious areas with biopsy findings. OCT imaging correctly identified tumors confined to the mucosa with a sensitivity and specificity of 90% and 89%, respectively. Muscle-invasive tumors were detected in 7 of 7 lesions with 100% sensitivity, 90% specificity, and 92% accuracy. Optical coherence tomography is a rapid, easy-to-use tool that can help differentiate Ta and T1 tumors and identify muscle-invasive bladder tumors. It provides real-time microarchitectural information that can aid in the evaluation of bladder tumors and adjacent and remote urothelium.

Virtual cystoscopy in the evaluation of bladder tumors

Objective: The objective of this study was to investigate the value of contrast material-filled virtual cystoscopy in the detection of bladder tumors. Materials and methods: Thirty-nine patients who had recent diagnosis or were followed up due to priory history of bladder tumor underwent virtual cystoscopy. After the intravenous injection of contrast medium, the bladder was examined with helical computed tomography (CT) scan. The data were transferred to a workstation for interactive navigation using surface rendering. Two radiologists independently interpreted the axial and virtual images, and discrepancies were resolved by consensus. The results of virtual cystoscopy were compared with the findings of conventional cystoscopy. Results: Forty-nine of 54 bladder lesions detected with conventional cystoscopy in 33 patients were also shown on virtual images. On virtual cystoscopy, three of the seven lesions 5 mm or smaller in diameter could be identified. There were no false-positive findings. The sensitivity of the technique was 96.2% for polypoid tumors and 88.9% for sessile lesions. When axial and virtual images were evaluated together, the sensitivity rate increased to 94.4%. Conclusion: Bladder tumors can be diagnosed noninvasively using contrast medium-filled virtual cystoscopy. Evaluation of both the axial and virtual images increases the sensitivity of the technique.

A retrospective study of DNA ploidy of transitional cell carcinoma of urinary bladder using flow cytometry.

Transitional cell carcinoma is the most common malignancy of urothelial origin in urinary bladder. Its aggressive potential cannot be reliably predicted from the histologic appearance alone. Recently, there has been extensive studies of DNA ploidy using flow cytometry in prospective analysis of bladder tumors with fresh tissue. Techniques for the preparation of paraffin embedded tissue have been developed and successfully applied in retrospective evaluation of bladder tumors. These studies had demonstrated the correlation between histological grading and DNA ploidy, and between clinical staging and DNA ploidy. Our retrospective study showed that the cytometric method is superior to histologic grading in the predictability of patient's survival, especially in the low grade (grades 1 and 2) group. In the preparation of paraffin embedded tissue, the high background debris and wide range of coefficients of variation had some interference in the interpretation for the histogram of FCM (only 80% of the cases studied are interpretable). This interference might be due to the variation of conditions of tissue processing and fixation. The evaluation of S phase fraction and G2/M fraction is also difficult to perform because of the same problem. There was an encouraging result in the evaluation of DNA ploidy using flow cytometry with paraffin embedded tissue, although a relatively small number of patients were included in this study. The value of this technique application in clinical evaluation of the prognosticity was obvious.

Flow Cytometry Detection and Evaluation of Bladder Tumors

The diagnosis and classification of bladder cancer are based primarily on histologic and cytologic light microscopy. The significant cytologic alternations are abnormal (increased) DNA content and structural changes in chromatin. Measurements of DNA content carried out by flow cytometry on suspensions of tumor cells and bladder irrigation specimens correlate well with clinical and biopsy findings. Badalament et al (Badalament RA, Kimmel M, Gay H, et al. Cancer 1987;59:2078-2085) reported that a single bladder wash flow cytometry correctly detected 83% of bladder cancers. The technique is most sensitive in detecting early, in situ, and superficially invasive carcinoma. In 100 urologic patients with non-neoplastic disease of the bladder, Klein et al (Klein FA, Herr HW, Sogani PC, et al. J Urol. 1982;127:946-948) reported only two false-positive examinations. Flow cytometry appears to be at least as valuable as conventional urinary cytology, without the need of an experienced cytopathologist. However, as specimens must be collected by bladder irrigation via catheter or cytoscope, the technique is most suitable not for population screening, but in monitoring high-risk populations: industrial workers or others exposed to carcinogens, persons with a history of urothelial tumors, and adult patients referred for urologic examinations because of hematuria, unexplained, recurrent cystitis, or other urologic symptoms. DNA flow cytometry also has been valuable in monitoring the conservative treatment of bladder cancer and of predictive value in the intravesical bacille Calmette-Guérin treatment of superficial carcinomas of the bladder. Dual parameter measurements of DNA content and antigen expression are now under evaluation, as are measurements of chromatin structure alteration, metabolism, and proliferative rate. These promise to discriminate subsets of bladder cancer that may be predictive of clinical behavior.

Evaluation of bladder tumors by endoscopic procedures.

Evaluation of bladder tumors by endoscopic procedures.