Staging Of Urinary Bladder Cancer Research Articles

Role of multiparametric magnetic resonance imaging in the diagnosis and staging of urinary bladder cancer.

ObjectivesTo assess the role of multiparametric magnetic resonance imaging (mp-MRI) in the diagnosis and staging of urinary bladder cancer (BC).Materials and methodsFifty patients diagnosed with bladder masses underwent mp-MRI study. The results of 3 image sets were analyzed and compared with the histopathological results as a reference standard: T2-weighted image (T2WI) plus dynamic contrast-enhanced (DCE), T2WI plus diffusion-weighted images (DWI), and mp-MRI, including T2WI plus DWI and DCE. The diagnostic accuracy of mp-MRI was evaluated using receiver operating characteristic curve analysis.ResultsThe accuracy of T2WI plus DCE for detecting muscle invasion of BC was 79.5% with a fair agreement with histopathological examination (κ = 0.59); this percentage increased up to 88.6% using T2WI plus DWI, with good agreement with histopathological examination (κ = 0.74), whereas mp-MRI had the highest overall accuracy (95.4%) and excellent agreement with histopathological data (κ = 0.83). Multiparametric MRI can differentiate between low- and high-grade bladder tumors with a high sensitivity and specificity of 93.3% and 98.3%, respectively.ConclusionsMultiparametric MRI is an acceptable method for the preoperative detection and accurate staging of BC, with reasonable accuracy in differentiating between low- and high-grade BC.

Comparison between conventional and diffusion-weighted magnetic resonance imaging in predicting grade and stage of urinary bladder cancer

BackgroundUrinary bladder cancer is the second most common neoplasm of the urinary tract. Tumor staging and regional disease spread are the strongest predictors of treatment outcome. Our study aims to compare the diagnostic performance of conventional and diffusion-weighted magnetic resonance imaging (DW-MRI), using a 3T MR scanner, in grading and staging of urinary bladder cancer with histopathologic correlation.ResultsThe sensitivity, specificity, and accuracy of combined use of HR T2WI and DWI were better than using HR T2WI only to differentiate T1 stage from further stages (95%, 100%, and 98%, respectively). Differentiating organ confined bladder cancer (T1 and T2 stages) from tumors with extravesical extension was better when using both HR T2WI and DWI than using HR T2WI (accuracy 100% and 93%, respectively). Kappa agreement was better when using both HR T2WI and DWI than HR T2WI only (0.963 and 0.496 respectively). Grade III lesions showed statistically significant lower ADC values than grades I and II with ADC cut off value ≤ 0.95 × 10−3 mm2/s. No statistically significant difference was found in ADC values between transitional cell carcinoma (TSC) and other cell types.ConclusionCombined use of DWI and HR T2WI provides more accurate urinary bladder cancer staging and prediction of aggressiveness of certain histologic grade (GIII lesions) using ADC values. 3 T scanners have the potential to achieve higher diagnostic capability in evaluation of urinary bladder cancer.

DIAGNOSIS AND STAGING OF BLADDER CANCER

Urinary bladder cancer is a fairly common pathology in the structure of cancer morbidity, both in the world and in the Russian Federation, especially in elderly patients. As is well known, the 5-year survival and disease-free survival rates directly correlate with the stage of the tumor process, which determines the significance of an adequate assessment of the distribution of tumors for planning treatment approach. This article provides an overview of scientific studies on imaging techniques that are used for preoperatively staging of urinary bladder cancer. Currently, the most interesting is multiparametric-MRI, which has a number of advantages over other imaging methods including: non-invasiveness, high tissue and spatial visualization and the absence of ionizing radiation. The appearance of this method contributed to an increase in diagnostic effectiveness in assessing the distribution of urinary bladder cancer. However, there are a number of unresolved issues related to errors in interpreting the depth of invasion and evaluation of regional lymphatic outflow, which require detailed study and analysis.

Diffusion weighted magnetic resonance imaging in bladder cancer, is it time to replace biopsy?

IntroductionTo assess if the apparent diffusion coefficient (ADC) value of magnetic resonance imaging (MRI) can discriminate between the cell type, histological grade and improve staging of urinary bladder cancer (BC).Material and methods102 patients with urinary bladder masses underwent MRI using a 1.5 T machine. T2 weighted and diffusion weighted imaging (DWI) using b values of 0, 150, 500 and 1000 s/mm2 were done. The ADC values of bladder masses were measured. These values were correlated with the histopathologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of T2WI, DWI and T2WI plus DWI for detecting bladder lesions were evaluated.RESULTSThe cut-off ADC value for diagnosing malignant bladder wall pathologies was ≤1 x 10-3 mm2/s with 94.5% sensitivity and 87.5% specificity. The mean ADC value of different malignant cell types was statistically insignificant. A significant difference in ADC values was found between G1 and G3 (P = 0.000), G2 and G3 (P = 0.045) but not between G1 and G2 (p = 0.066). Staging accuracy for differentiation between invasive and non-invasive lesions was nearly the same for all MRI data sets. For differentiation between organ confined (pT1–pT2) and non-organ confined lesions (pT3–pT4), staging accuracy was better in T2WI plus DWI (83%) as compared to DWI alone (77%) or T2WI alone (75%).ConclusionsAdding DWI and the ADC value to T2WI improve the accuracy of MRI in BC detection and staging. However, at this time point, MRI cannot replace transurethral resection (TUR) biopsy or distinguish sharply between all different histologic grades and cell types.

Role of magnetic resonance in evaluation of urinary bladder cancer

Objective The aim of this study was to prospectively evaluate the use of MRI as a noninvasive diagnostic tool for staging of bladder tumors using different magnetic resonance (MR) sequences: T2-weighted image (T2WI), diffusion-weighted image (DWI), and precontrast and postcontrast T1-weighted image. Background MRI with its superior resolution and supplemented with new emerging sequences is the optimal imaging modality for accurate local staging of bladder cancer, particularly for differentiation between the muscle-invasive and non-muscle-invasive urinary bladder tumors; it is a cornerstone in treatment decision making. Patients and methods The study protocol received institutional ethical committee approval, and informed consent was obtained. Between November 2014 and November 2015, 50 consecutive patients (44 men and 6 women; mean age: 64.3 years; range: 44–85 years) who presented with gross hematuria or suspected urinary bladder tumors were enrolled prospectively. All patients underwent MR examination followed by conventional cystoscopy. The patients were evaluated using T2-weighted high-spatial-resolution MRI of the urinary bladder, followed by diffusion-weighted-MRI. Precontrast T1 (with or without fat suppression) and immediate postgadolinium injection were performed if there were no contraindications. Results Of all 50 patients, four (8%) were at T1, 12 (24%) were at T2, 23 (46%) were at T3, and 11 (22%) were at T4. The most common symptom was gross hematuria (33 patients; 66%). The overall accuracy of T2WI, DWI, and postcontrast imaging sequences in differentiating stage Tis to T2 tumors from T3 to T4 tumors was 88, 98, and 94%, respectively. DWI has a higher overall accuracy compared with both T2WI and postcontrast T1-weighted image in T staging of bladder cancer. Conclusion MRI with new emerging sequences (diffusion-weighted and contrast-enhanced) is highly reliable for accurate local staging of urinary bladder cancer, which is similar to that of conventional cystoscopy. This noninvasive method could be efficiently used for evaluating patients with hematuria of lower urinary tract origin.

The role of diffusion-weighted magnetic resonance imaging in T staging and grading of urinary bladder cancer

PurposeTo evaluate the ability of diffusion-weighted imaging (DWI) in T staging of urinary bladder cancer and the correlation between the apparent diffusion coefficient (ADC) and tumor grading. Patients and methodsThis study included 40 patients with bladder mass diagnosed by ultrasonography. MR imaging sequences included, T2WI, DWI, ADC and T1 postcontrast MRI were done. The correlation between magnetic resonance findings and histopathological results was done. ResultsOf all forty patients, 14 patients (35%) were T1, 18 (45%) patients were T2, and 8 (20%) patients were T3. The overall accuracy of T2WI, DWI and postcontrast imaging sequences in differentiating superficial from invasive tumor was 60%, 85% and 75% respectively. The overall accuracy of T2WI, DWI and postcontrast imaging sequences in differentiating organ confined from non-organ confined tumor was 80%, 90% and 70% respectively. The mean ADC value was 0.95±0.13×10–3mm2/s in low grade tumors and 0.69±0.12×10–3mm2/s in high grade tumors. ConclusionDWI has a higher overall accuracy compared to both T2WI and postcontrast T1WI in T staging of bladder cancer, and also ADC value can predict the tumor grade. So, DWI can be recommended as promising MRI sequence in urinary bladder T staging and grading.

Comparison of dynamic contrast-enhanced and diffusion weighted magnetic resonance image in staging and grading of carcinoma bladder with histopathological correlation.

Background:Bladder cancer is the second most common neoplasm of the urinary tract worldwide. Dynamic contrast-enhanced and diffusion-weighted MRI has been introduced in clinical MRI protocols of bladder cancer because of its accuracy in staging and grading.Aim:To evaluate and compare accuracy of Dynamic contrast enhanced (DCE) and Diffusion weighted (DW) MRI for preoperative T staging of urinary bladder cancer and find correlation between apparent diffusion coefficient (ADC) and maximum enhancement with histological grade.Materials and Methods:Sixty patients with bladder cancer were included in study. All patients underwent Magnetic Resonance Imaging (MRI) on a 1.5-T scanner with a phased-array pelvic coil. MR images were evaluated and assigned a stage which was compared with the histolopathological staging. ADC value and maximum enhancement curve were used based on previous studies. Subsequently histological grade was compared with MR characteristics.Results:The extent of agreement between the radiologic staging and histopathological staging was relatively greater with the DW-MRI (κ=0.669) than DCE-MRI (κ=0.619). The sensitivity, specificity, and accuracy are maximum and similar for stage T4 tumors in both DCEMRI (100.0, 96.2 and 96.7) and DW-MRI (100.0, 96.2 and 96.7) while minimum for stage T2 tumors - DCEMRI (83.3, 72.2, and 76.7) and DWI-MRI (91.7, 72.2, and 80).Conclusion:MRI is an effective tool for determining T stage and histological grade of urinary bladder cancers. Stage T2a and T2b can be differentiated only by DCE-MRI. Results were more accurate when both ADC and DCE-MRI were used together and hence a combined approach is suggested.

Preoperative T Staging of Urinary Bladder Cancer: Efficacy of Stalk Detection and Diagnostic Performance of Diffusion-weighted Imaging at 3T

We evaluated the ability of diffusion-weighted imaging (DWI) at 3 tesla for diagnosing T stage and detecting stalks in bladder cancer. In total, 39 consecutive patients with bladder tumors underwent magnetic resonance (MR) imaging that included T2-weighted imaging (T2WI) and DWI using a 3T MR scanner. Two radiologists interpreted T2WI plus DWI and T2WI for diagnosis of T stage and for detection of stalks. We used McNemar's test to examine differences in diagnostic performance and Fisher's exact test to evaluate differences in stalk detection frequency. Specificity and accuracy in differentiating T1 tumors from T2 to T4 tumors were significantly better with T2WI plus DWI (83% [20/24] and 85% [33/39]) than T2WI (50% [12/24] and 67% [26/39]; P = 0.02), and accuracy for diagnosing tumor stage was significantly better with T2WI plus DWI (82% [32/39]) than T2WI alone (59% [23/39]; P = 0.03). The observers identified stalks in 11 tumors by T2WI (48% [11/23]) and 17 by DWI (74% [17/23]) (P < 0.03). DWI at 3T was superior to T2WI for evaluating the T stage of bladder cancer, particularly in differentiating T1 tumors from those T2 or higher, and in detecting stalks of papillary bladder tumors.

Current Staging Procedures in Urinary Bladder Cancer.

Currently computed tomography (CT) represents the most widely used standard imaging modality in muscle-invasive urinary bladder cancer. Visualization of local tumor or depth of invasion as well as lymph node staging, however, is often impaired. Magnetic resonance imaging (MRI) with diffusion-weighted sequences, determination of apparent diffusion coefficient (ADC) values or utilization of superparamagnetic iron nanoparticles potentially exhibits advantages in the assessment of local tumor or lymph node involvement and therefore might play a role in routine staging of urinary bladder cancer in the future. Likewise, positron emission tomography (PET) with the currently utilized tracers 18F-FDG, 11C-choline and 11C-acetate is investigated in bladder cancer patients—mostly in combination with diagnostic CT. Although promising results could be obtained for these PET/CT examinations in smaller series, their true value cannot be determined at present.

Clinical Value of T2-Weighted Imaging Combined with Diffusion-Weighted Imaging in Preoperative T Staging of Urinary Bladder Cancer: A Large-Scale, Multiobserver Prospective Study on 3.0-T MRI

To prospectively assess the incremental value of diffusion-weighted imaging (DWI) combined with T2-weighted images (T2WI) in determining the T stage of bladder cancer by using pathologic findings as the reference standard. This study is approved by the institutional review board; informed consent was waived. The study includes 362 patients (age range, 48-87 years; mean, 71 years) who underwent 3.0-T magnetic resonance imaging and histologic examination. Three observers with varying experience levels reviewed the T2WI data alone, DWI data alone, and combined T2WI and DWI data. Sensitivity, specificity, accuracy, and area under curve (AUC) were determined with the Z test after adjusting for data clustering. For differentiating Tis to T1 tumors from T2 to T4 tumors, the AUCs for T2WI and DWI (0.97 for observer 1 and 0.96 for observer 2) were greater than those for the DWI alone (0.92 for observer 1 and 0.90 for observer 2) (P < .05). Observer 3 had similar AUCs for T2WI and DWI compared to DWI alone. The accuracy of T2WI and DWI (observer 1, 98%; observer 2, 96%; observer 3, 92%) was greater than that of DWI alone (observer 1, 92%; observer 2, 90%; observer 3, 87%) for all observers (P < .05). The specificity of T2WI and DWI (observer 1, 100%; observer 2, 98%; observer 3, 93%) was greater than that of DWI alone (observer 1, 92%; observer 2, 90%; observer 3, 87%) for all observers (P < .05). Sensitivity was not improved even when T2WI and DWI were used. For differentiating Tis to T2 Tumors from T3 to T4 Tumors, the overall accuracy, specificity, and AUC for diagnosing T2 or higher stages were not significantly improved by combiningT2WI and DWI. T2WI combined with DWI can be a reliable sequence for preoperative evaluation of T stage urinary bladder cancer. It is particularly more useful in differentiating T1 or lower tumors from T2 or higher tumors compared to DWI alone.

Diuretic 18F-FDG PET/CT imaging for detection and locoregional staging of urinary bladder cancer: prospective evaluation of a novel technique

Positron emission tomography/computed tomography (PET/CT) with (18)F-fluorodeoxyglucose (FDG) has been used with limited success in the past in primary diagnosis and locoregional staging of urinary bladder cancer, mainly because of the pharmacokinetics of renal excretion of (18)F-FDG. In the present prospective study, we have evaluated the potential application of diuretic (18)F-FDG PET/CT in improving detection and locoregional staging of urinary bladder tumours. Twenty-five patients suspected of having primary carcinoma of the urinary bladder were evaluated prospectively for diagnosis and staging. All of these 25 patients underwent conventional contrast-enhanced computed tomography (CECT) of the abdomen/pelvis and whole-body diuretic (18)F-FDG PET/CT. In addition, pelvic PET/CT images were obtained using the special technique of forced diuresis using intravenous furosemide (20-40mg). Of the 25 patients, 10 underwent radical cystectomy and 15 underwent transurethral resection of the bladder tumour (TURBT). Results of CECT and diuretic (18)F-FDG PET/CT were compared considering histopathology as a reference standard. Of the 25 patients, CECT detected a primary tumour in 23 (sensitivity 92%), while (18)F-FDG PET/CT was positive in 24 patients (sensitivity 96%). Mean size and maximum standardized uptake value of the bladder tumours were 3.33cm (range 1.6-6.2) and 5.3 (range 1.3-11.7), respectively. Of the 25 patients, only 10 patients underwent radical cystectomy based on disease status on TURBT. Among those ten patients, nine had locoregional metastases. Among the nine patients who had positive lymph nodes for metastasis on histopathology, CECT and PET/CT scan had a sensitivity of 44 and 78%, respectively. (18)F-FDG PET/CT was found to be superior to CECT in the detection of the primary tumour and locoregional staging (p < 0.05). Diuretic (18)F-FDG PET/CT is highly sensitive and specific and plays an important role in improving detection of the primary tumour and locoregional staging of urinary bladder tumours. Diuretic (18)F-FDG PET/CT demonstrated a higher diagnostic value when compared with CECT in these patients.

PET/CT in renal and bladder cancers

FDG is the most frequently used positron emission tomography probe but it has certain limitations when used in urological cancers due to its urinary elimination, which prevents the proper visualization of the bladder and kidneys. The introduction of co-registered PET and computed tomography (PET/CT) represents a major advance in technology and now become the new standard for many cancers. For the staging and surveillance of renal cell cancer, FDG PET/ CT had results that were at least as good as conventional methods, which are potentially harmful for the remained renal function. FDG-PET/CT is able to evaluate early response to sunitinib or sorafenib treatment in metastatic renal cell cancer. An early decrease in the mean glucose uptake was found in both soft and skeletal lesions after treatment, thus PET seems to be more advantageous compared with RECIST evaluation. In addition, the survival of patients with advanced renal cell cancer can be predicted by evaluating their SUVmax using FDG-PET/CT. Although urinary bladder cancer demonstrates sufficiently increased FDG uptake, primary tumors are difficult to identify due to the renal excretion of FDG. The accuracy of FDG-PET/CT in metabolically active metastases is generally higher when compared to conventional CT except for identifying small lung deposits. PET/CT with delayed images after a diuretic and oral hydration may improve detection of locally recurrent or residual UBC and could replace standard CT and bone scintigraphy in the presurgical staging and monitoring of patients with urinary bladder cancer. 18F-choline PET may be useful for staging of urinary bladder cancer in addition to FDG PET.

Initial Results with 11C-Acetate Positron Emission Tomography/Computed Tomography (PET/CT) in the Staging of Urinary Bladder Cancer

To investigate the utility of (11)C-acetate positron emission tomography/computed tomography (PET/CT) for staging of bladder cancer and response assessment after neoadjuvant chemotherapy. Seventeen patients underwent (11)C-acetate PET/CT ≤1 month before radical cystectomy (RC) and pelvic lymph node dissection (PLND). Ten patients had undergone neoadjuvant chemotherapy prior to PET. Histopathology from RC and PLND (n = 16) or nodal biopsy (n = 1) served as gold standard. Eight of 10 residual tumors showed abnormal (11)C-acetate uptake; two cases of residual TiS were false negative, three cases were false positive, and three true negative. Three patients showed true positive uptake in LN. False positive uptake occurred in 14 LN regions secondary to granulomatous disease after prior intravesical Bacillus Calmette-Guerin (BCG) therapy. (11)C-acetate has good sensitivity for bladder cancer and LN metastases. However, false positive uptake due to inflammation or granulomatous infection can occur, limiting the staging utility of (11)C-acetate after prior intravesical BCG therapy.

Preoperative T Staging of Urinary Bladder Cancer: Does Diffusion-Weighted MRI Have Supplementary Value?

The objective of our study was to evaluate whether diffusion-weighted MRI has supplementary value in the preoperative T staging of urinary bladder cancer. Nineteen consecutive patients (18 men and one woman; age range, 55-83 years; mean, 71 years) known to have or suspected of having urinary bladder cancer underwent MRI at our institution. Urinary bladder cancer was pathologically proven in 18 patients. The pathologic stages were T1 in 14 patients, T2 in two, T3 in one, and T4 in one. Three separate MR image sets were retrospectively reviewed by two independent radiologists: unenhanced T1-weighted images (TR/TE, 607/10) and T2-weighted images (TR(eff)/TE(eff), 4,415/100); unenhanced T1-weighted, T2-weighted, and gadolinium-enhanced images (TR/TE, 10/4.2); and unenhanced T1-weighted, T2-weighted, and diffusion-weighted images (TR(eff)/TE(eff), 2,191/69; b factor, 1,000 s/mm(2)). The radiologists, who were blinded to the pathology findings, assigned T stages and confidence levels for tumors of stage T2 or greater. We used pathologic stages documented in the official pathologic reports as the standard of reference. Observer performance was tested using Spearman's rank correlation, the McNemar test, and receiver operating characteristic (ROC) curve analysis. The correlation between the radiologic and pathologic stages was greater with the diffusion sequence (rho = 0.66) than with the unenhanced (0.62) or gadolinium-enhanced (0.62) sequence (p = 0.34). The sensitivity, specificity, accuracy, and area under the ROC curve for tumors of stage T2 or greater were 80%, 79%, 79%, and 0.71 for the unenhanced sequence; 80%, 79%, 79%, and 0.77 for the gadolinium sequence; and 40%, 93%, 79%, and 0.56 for the diffusion-weighted sequence, respectively (p > 0.05). Our results suggest that diffusion-weighted MRI might have high specificity for the detection of invasive urinary bladder tumors. Patients with suspected urinary bladder carcinomas may well be evaluated by MRI including diffusion-weighted imaging for better preoperative T staging.

Further Characterization of the Muscle Layers and Lamina Propria of the Urinary Bladder by Systematic Histologic Mapping

The muscularis mucosae (MM) and muscularis propria (MP) are important landmarks for pathologic tumor (pT) staging of urinary bladder cancer, which is the quintessential prognostic factor. In our routine practice, we have occasionally noted patterns of MM, which do not always conform to the originally described configuration of thin slender bundles arranged in a single layer of interrupted, dispersed, or continuous muscle. We evaluated the lamina propria (LP), MM, and MP characteristics in 35 urinary bladder resection specimens with systematic sampling from the dome, trigone, anterior, posterior, right, and left lateral walls. Among the subsites, the trigone had a relatively flatter surface and attenuated LP depth (0.46 to 1.58 mm), about half of the thickest region which was the dome (0.98 to 3.07 mm). The MM was typically in individual or small groups of slender and wavy fascicles or wispy fibers. MM also had focal to rarely extensive hyperplastic appearance (53%, most common in dome) with 2 recognizable patterns: (a) aggregates of hyperplastic MM with haphazard outlines (33%) distinct from that of MP, and (b) hyperplastic compact MM with parallel muscle fibers and regular outline arranged singly or in small groups (45%) that occasionally strongly resembled MP muscle but distinguishable from it on the basis of the location in the LP. By distribution, these muscle bundles were more typically dispersed or formed a discernable layer (41%) as discontinuous or infrequently near-continuous layer. The LP vascular plexus was present in every section most often in association with the MM muscle; however, variations in the distribution were observed. The MP most commonly had a relatively regular interface with the LP. A distinctive pattern was noted in the trigone where occasionally there was gradual diminution of size of the MP muscle bundles as they extended to almost a suburothelial location. In 22%, isolated or small groups of compact regular hyperplastic MM muscle bundles were noted in deep LP situated between the more typical slender MM layer and the MP. In conclusion, there are additional patterns of MM other than previously described. Awareness of the occasionally hyperplastic appearance of MM muscle is important to prevent overstaging of invasive urothelial carcinoma. In transurethral resection specimens, lack of orientation may preclude distinction of the hyperplastic MM from true MP in these rare situations. The number and orientation of muscle bundles, relationship to urothelium and vascular plexus, and comparison with more characteristic MP, if present, would be helpful; isolated bundles immediately adjacent to the urothelium with loose haphazard fiber orientation and irregular outlines favor MM over MP muscle. The hyperplastic MM mimicking MP may be more challenging; isolated muscle bundles immediately adjacent to the urothelium would favor hyperplastic pattern of MM over MP muscle. Topographical variations exist among the subsites, the more superficial location of the MP and the rarity of MM in the trigone, relative abundance of hyperplastic MM in dome, and presence of the more superficial ureteral MP at its insertion in the bladder complicate the traditional pT stage evaluation of invasion in these regions. The inconsistency of a distinct MM layer and variations in the LP vascular plexus indicate that substaging of pT1 would be problematic and thus provides further support to the World Health Organization/International Society of Urological Pathology 1998 and World Health Organization 2004 recommendation against its implementation at the current time.

2181: The possibilities of 3D sonography in diagnosis and staging of urinary bladder cancer

Objectives: Transrectal and transvaginal (for women) sonography is standard part of complex examination in patients with urinary bladder cancer (UBC). The method allows to visualize three layers of urinary bladder wall, paravesical structures and tumor invasion depth. Investigation goal was to reveal the possibilities of sonography with three-dimensional reconstruction in estimation of invasion depth in cases with UBC. Methods: Transrectal or transvaginal sonography with three-dimensional reconstruction was performed in 40 patients with UBC. 3D US angiography was used in all cases. We studied tumors quantity, their location and invasion depth. All diagnoses were confirmed morphologically. Results: Overall sensitivity of both methods in disclosure of tumors was 95%. There were difficulties and mistakes if tumor size was less then 0,4 cm. Sensitivity of both methods (standard investigation and 3D sonography) for invasion depth detection was the same: 85% in T1–T2 stage, 94% in T3 stage and 100% in T4 stage. However, three-dimensional model is more visual and provides showing any cut of tumor in any time. Conclusions: The possibilities of sonography with three-dimensional reconstruction and standard sonography in patients with UBC are the same. However, the method is more visual and may be useful in surgery treatment planning.

Positron Emission Tomography in the Diagnosis and Staging of Urinary Bladder Cancer

Positron Emission Tomography in the Diagnosis and Staging of Urinary Bladder Cancer

Positron emission tomography in the diagnosis and staging of urinary bladder cancer.

Evaluation of positron emission tomography (PET) using (18)fl 18F-2-fluoro-2-deoxy-D-glucose (18FDG) and L-methyl-11C-methionine in the diagnosis and staging of urinary bladder carcinoma. Twenty-three patients with biopsy-proven urinary bladder carcinoma were examined with PET after intravenous injection of 11C-methionine; 2 were also examined with 18FDG. The results from the PET investigations were compared with CT or MR findings and TNM classification before and after treatment. The urinary excretion of 18FDG prevented distinction of the primary tumour from the surrounding tracer. With 11C-methionine it was possible to detect 18/23 primary tumours. A trend was seen, suggesting that the higher the uptake values of 11C-methionine in the tumour, the greater the tumour stage. It is possible to visualize urinary bladder tumours larger than 1 cm in diameter with PET using (11)C-methionine, but the value of the method in the staging of the lesions is not superior to conventional methods.

Positron Emission Tomography in the Diagnosis and Staging of Urinary Bladder Cancer

Positron Emission Tomography in the Diagnosis and Staging of Urinary Bladder Cancer

Immunotargeting with monoclonal cytokeratin 8 antibodies of human urothelial cancer transplanted to nude mice.

The possibility of using cytokeratin antibodies for the radioimmunolocalization of urinary bladder cancer was studied. A monoclonal murine IgG antibody was raised against cytokeratin 8 and labelled with iodine-125; normal murine IgG was used for control purposes. The urothelial cancer cell line RT4 was transplanted into immunodeficient nude mice. The anti-cytokeratin 8 antibody was administered intraperitoneally and its uptake in the tumour and other organs was analyzed with a computerized gamma camera. Optimal scintigraphic visualization occurred 11 days after antibody administration. The tumour/blood ratio of the specific antibody was 5.64 (+/- 5.01 SD) on day 11, compared with 0.73 (+/- 0.35 SD) in the control. Autoradiography demonstrated antibody uptake preferentially in viable sections of the tumour. The antibody uptake is presumed to be the result mainly of binding to the released cytokeratin in and around cells lysed during natural cellular death. The monoclonal murine anti-cytokeratin antibody is of potential interest in studies aimed at improving the clinical staging of urinary bladder cancer.