Suspected Bladder Cancer Research Articles

Diagnostic accuracy of urinary cytokeratin fragment-19 (CYFRA21-1) for bladder cancer

Bladder cancer is known for its high recurrence rate and requires constant patient monitoring. To confirm the diagnosis, a tissue sample from a cystoscopy is required, which the patient often avoids. Urine has the potential to be utilized as a diagnostic fluid because of its non-invasive nature and various biomarker contents. The aim of this study was to determine the diagnostic value of cytokeratin fragment-19 (CYFRA21-1) level in urine for diagnosing bladder cancer. This single-center cross-sectional study was performed with eligible inclusion were adults aged ≥18 years who presented with hematuria and suspected bladder cancer from imaging. Patients with a history of intravesical chemotherapy, radiotherapy and immunotherapy were excluded. Urine samples were collected prior to the cystoscopy. Detection of urinary CYFRA21-1 was carried out using the ELISA method. Of 154 patients included in the study, the diagnosis of bladder cancer was confirmed in 92 patients. Patients with bladder cancer had significantly higher urinary CYFRA21-1 levels compared to the non-bladder cancer group. The sensitivity, specificity, positive and negative predictive value, and positive likelihood ratio of the CYFRA21-1 were 80.4%, 43.5%, 67.9%, 60% and 1.425, respectively. The area under the curve for CYFRA21-1 was 0.608, computed from a receiver operating curve with a cut-off value of 13.3 ng/mL. In conclusion, urinary CYFRA21-1 levels have moderate diagnostic accuracy in determining bladder cancer among suspected individuals. Due to its high sensitivity, this biomarker could potentially be used alongside other screening tools for bladder cancer detection.

Development and Validation of a Contrast-Enhanced US VI-RADS for Evaluating Muscle Invasion in Bladder Cancer.

Background Contrast-enhanced US (CEUS) can be used preoperatively for evaluating muscle invasion in bladder cancer, which is important for determining appropriate treatment. However, diagnostic criteria for assessing this at CEUS have not been standardized. Purpose To develop and validate a CEUS Vesical Imaging Reporting and Data System (VI-RADS) for evaluating muscle invasion in bladder cancer. Materials and Methods This single-center prospective study consecutively enrolled patients with suspected bladder cancer. Participants underwent transabdominal or intracavity CEUS between July 2021 and May 2023. Participants were divided into a training set and a validation set at a 2:1 ratio based on the chronologic order of enrollment. The training set was used to identify major imaging features to include in CEUS VI-RADS, and the likelihood of muscle invasion per category was determined using a pathologic reference standard. The optimal VI-RADS category cutoff for muscle invasion was determined with use of the maximum Youden index. The validation set was assessed by novice and expert readers and used to validate the diagnostic performance and interreader agreement of the developed system. Results Overall, 126 participants (median age, 64 years [IQR, 57-71 years]; 107 male) and 67 participants (median age, 64 years [IQR, 56-69 years]; 49 male) were included in the training and validation set, respectively. In the training set, the optimal CEUS VI-RADS category cutoff for muscle invasion was VI-RADS 4 or higher (Youden index, 0.77). In the validation set, CEUS VI-RADS achieved good performance for both novice and expert readers (area under the receiver operating characteristic curve, 0.80 [95% CI: 0.70, 0.90] vs 0.88 [95% CI: 0.80, 0.97]; P = .09). The interreader agreement regarding the evaluation of CEUS VI-RADS category was 0.77 (95% CI: 0.65, 0.85) for novice readers, 0.87 (95% CI: 0.79, 0.92) for expert readers, and 0.78 (95% CI: 0.70, 0.84) for all readers. Conclusion The developed CEUS VI-RADS showed good performance and interreader agreement for the assessment of muscle invasion in bladder cancer. Chinese Clinical Trial Registry no. ChiCTR2100049435 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Morrell in this issue.

National audit of patient reported experience of radical cystectomy for bladder cancer pathways

AbstractObjectiveThe objective of this study was to measure and describe the national patient experience of radical cystectomy (RC) pathways in the UK using the validated Cystectomy‐Pathway Assessment Tool (C‐PAT).Patients and MethodsA cohort of 1081 patients who underwent RC for bladder cancer, between 1 January 2021 and 31 July 2022 at 33 UK cystectomy centres, returned completed C‐PAT responses. SPSS was employed for data summary statistics, including median, interquartile range, Mann Whitney U test or Chi‐square test with a 95% confidence interval to assess statistical significance between potentially associated variables. Open‐text responses in the C‐PAT tool were analysed and coded using NVivo software.ResultsIn this cohort, the greatest perceived delay in the RC pathway, reported by 19% of patients (n = 208), was at the GP consultation to first hospital referral stage with suspected bladder cancer. Around 10% of patients perceived delays at each of the other stages in their pathway. Cancer nurse specialist (CNS) contact was strongly associated with an improved patient experience (p < 0.001); however, 9.5% of patients reported that they were not assigned a cancer nurse specialist in their pathway. Overall, 96% (n = 1028) reported their experience of RC pathway care to be good or excellent. There were no significant differences in reported patient experience found between cystectomy centres.ConclusionThis audit demonstrates the feasibility of measuring patient experience of RC pathways at scale. The C‐PAT tool demonstrated utility in identifying specific pathway areas for quality improvement. Overall UK patients report a high quality pathway experience. A focus on improving the referral pathway between primary and secondary care is necessary.

In vivo assessment of bladder cancer with diffuse reflectance and fluorescence spectroscopy: A comparative study.

The aim of this work is to assess the performance of multimodal spectroscopic approach combined with single core optical fiber for detection of bladder cancer during surgery in vivo. Multimodal approach combines diffuse reflectance spectroscopy (DRS), fluorescence spectroscopy in the visible (405 nm excitation) and near-infrared (NIR) (690 nm excitation) ranges, and high-wavenumber Raman spectroscopy. All four spectroscopic methods were combined in a single setup. For 21 patients with suspected bladder cancer or during control cystoscopy optical spectra of bladder cancer, healthy bladder wall tissue and/or scars were measured. Classification of cancerous and healthy bladder tissue was performed using machine learning methods. Statistically significant differences in relative total haemoglobin content, oxygenation, scattering, and visible fluorescence intensity were found between tumor and normal tissues. The combination of DRS and visible fluorescence spectroscopy allowed detecting cancerous tissue with sensitivity and specificity of 78% and 91%, respectively. The addition of features extracted from NIR fluorescence and Raman spectra did not improve the quality of classification. This study demonstrates that multimodal spectroscopic approach allows increasing sensitivity and specificity of bladder cancer detection in vivo. The developed approach does not require special probes and can be used with single-core optical fibers applied for laser surgery.

A Case of Primary Adenocarcinoma Mucinous Subtype of the Bladder

A 48-year-old man who presented with asymptomatic gross hematuria in July 202X had been followed up without treatment. In January 202X, he was referred to our department due to the exacerbation of his hematuria. Contrast-enhanced magnetic resonance imaging revealed bladder cancer suggested bilateral seminal vesicle and prostate invasion, and enlarged right internal and external iliac lymph nodes. The pathological diagnosis was mucinous bladder adenocarcinoma. Prostate biopsy results were negative. Upper and lower gastrointestinal examinations were unremarkable. We suspected bladder cancer cT4aN2M0. In March 202X＋1, the patient underwent robotic-assisted laparoscopic total bladder resection, pelvic lymph node dissection, and intracorporeal urinary tract modification (ileal conduit creation). The final diagnosis was primary mucinous adenocarcinoma pT4aN2M0 of the bladder. Given the heightened risk of recurrence, the patient was administered a three-month course of oxaliplatin and capecitabine (XELOX) as adjuvant postoperative chemotherapy. The patient remains free of progression at 8 months postoperatively. Adenocarcinoma of the bladder is an exceedingly rare entity, with no established chemotherapeutic protocols. Primary mucinous adenocarcinoma of the bladder is even more exceptional. Presently, only regimens similar to those for colorectal cancer or adenocarcinoma of unknown primary, including 5-fluorouracil, are considered. In our particular case, we elected to pursue XELOX therapy, aligning with the principles governing the management of colorectal cancer.

1017 Transurethral Laser Ablation for Non-Muscle Invasive Bladder Cancer: A Service Validation

Abstract Aim Transurethral laser ablation (TULA) for non-muscle invasive bladder cancer (NMIBC) allows outpatient treatment of suspected bladder cancer re-occurrence whilst avoiding the risks of the general anaesthetic. The COVID pandemic limited operating capacity was therefore TULA was adopted in a tertiary centre hospital in the UK in order to continue treatment for appropriate cases. We aimed to assess remission free period, the laser energy usage and waiting time for patients since the service started. Method A retrospective service evaluation since December 2020 till May 2022. All patients who were listed for TULA were eligible. Exclusion criteria was incomplete data and patients who did not have NMIBC. Demographic data, listing time, remission free period and lasering usage were all recorded. Patients were risk stratified as per the EAU guidelines; patients were upstaged to the higher category if there was incomplete data to stage accurately. Statistical analysis was conducting using a one-way ANOVA. Results 183 patients underwent TULA; 165 patients were included. The mean age was 79 years. The mean time was listing to procedure was 77 days. 72 patients had not had a flexible cystoscope post TULA. There was no significant difference between remission rates and re-occurrence rates (p = 0.544) between risk categories (p = 0.96). Conclusions The re-occurrence rates following TULA did not vary depending on the risk of NIMBC, nor did the energy usage. Longer collection periods are required to ascertain if this alters with time. Further research is required to assess if earlier treatment of more aggressive forms of NMIBC allows for lower reoccurrence rates.

Impact of COVID-19 on stage migration in bladder cancer: A single-centre retrospective comparative cohort analysis

Objectives: To evaluate whether the COVID-19 pandemic has increased the proportion of patients diagnosed with muscle invasive bladder cancer (MIBC) at first presentation and explore potential causes for this hypothesised stage migration. Subjects/Patients and Methods: All patients undergoing first transuretheral resection of bladder tumour (TURBT) between 2 January 2018 and 30 June 2021. The date of the lockdown restrictions was used to divide patients into pre-COVID and COVID cohorts. Data were collated retrospectively from electronic patient records. Variables included demographics data, TNM stage and presentation (emergent/elective). A comparative analysis of the two cohorts was undertaken using the chi-square test to evaluate for statistical significance. A p-value of <0.05 was regarded as significant. Results: A total of 1064 patient underwent a TURBT for a suspected bladder cancer in the study period. The number of patients in the pre-COVID and COVID cohorts was 704 and 360, respectively. Mean age was comparable between cohorts (74.7 vs 74.2 ( p = 0.46)) as was sex ratio (F:M (1:2.84 vs 1:2.95) p = 0.80). The proportion of patients with MIBC pre-COVID was 18% compared to 23.6% in the COVID cohort. This represents a 5.6% increase in the prevalence of first presentation MIBC during the COVID era ( p = 0.03 [95% confidence interval (CI) = 0.2–10.4]). The odds of a patient presenting with MIBC was 38% higher during the COVID era versus pre-COVID (odds ratio (OR) [95% CI] = 1.38 [1.01–1.85]). A significantly higher proportion of patients had metastases at presentation in the COVID cohort versus pre-COVID (4.4% vs 2.1% ( p = 0.034)). Conclusion: Our data would support the hypothesis that the COVID pandemic has precipitated a stage migration in the presentation of bladder cancer towards muscle invasive disease. This has implications in terms of patient outcomes as well as an increased demand on services to provide radial treatment. Potential reasons for the stage migration are patient-related factors and pathway failure due to widespread service disruption caused by COVID-19. Level of evidence: 3

Clinical practice guideline on bladder cancer (Part I)

AbstractBladder cancer represents one of the most prevalent malignant tumors affecting the urinary system. As per data disclosed by the National Cancer Registration Center of China in 2019, the incidence of bladder cancer was 5.80 per 100,000 in 2015, placing it as the thirteenth most common systemic malignancy. Bladder cancer poses a substantial threat to public health in China, underlining the critical importance of standardizing diagnosis and treatment to enhance clinical outcomes. This clinical practice guideline for bladder cancer centers on the etiologies, clinical presentations, and diagnostic procedures for suspected bladder cancer, in addition to the histopathology and staging of urothelial bladder cancer.

UroVysionTM Fluorescence In Situ Hybridization in Urological Cancers: A Narrative Review and Future Perspectives.

UroVysionTM is a fluorescence in situ hybridization assay that was developed for the detection of bladder cancer (UC accounted for 90%) in urine specimens. It consists of fluorescently labeled DNA probes to the pericentromeric regions of chromosomes 3, 7, 17 and to the 9p21 band location of the P16 tumor suppressor gene, which was approved by the Food and Drug Administration (FDA) in 2001 and 2005, respectively, for urine detection in patients with suspected bladder cancer and postoperative recurrence monitoring. Furthermore, recent studies also demonstrated that U-FISH was useful for assessing superficial bladder cancer patients' response to Bacillus Calmette-Guérin therapy and in detecting upper tract urothelial carcinoma. Therefore, positive U-FISH was well known to urologists as a molecular cytogenetic technique for the detection of UC. However, with the continuous enrichment of clinical studies at home and abroad, U-FISH has shown a broader application space in the detection of various urinary primary tumors and even metastatic tumors. This review focuses on summarizing the research status of U-FISH in UC, non-urothelial carcinoma and metastatic tumor, so as to strengthen urologists' more comprehensive understanding of the application value of U-FISH and better complete the accurate diagnosis and treatment of urological cancers.

Utility of an automatic adaptive iterative metal artifact reduction AiMAR algorithm in improving CT imaging of patients with hip prostheses evaluated for suspected bladder malignancy.

To compare the utility of a novel metal artifact reduction algorithm to standard imaging in improving visualization of key structures, diagnostic confidence, and patient-level confidence in malignancy in patients with suspected bladder cancer. Patients with hip implants undergoing CT urography for suspected bladder malignancy were enrolled. Images were reconstructed using 3 methods: (1) Filtered Back Projection (FBP), (2) Iterative Metal Artifact Reduction (iMAR), and (3) Adaptive Iterative Metal Artifact Reduction (AiMAR) strength 4. In multiple reading sessions, three radiologists graded visualization of critical anatomic structures and artifact severity (6-point scales, lower scores desirable), and diagnostic confidence in blinded fashion. They also graded patient-level confidence in malignancy based on imaging findings in each patient. Thirty-two patients (8 females) with a mean age of 74.5 ± 8.5years were included. The median (range) visualization scores for FBP, iMAR, and AiMAR were 3.6 (1.1-4.9), 1.6 (0.3-2.8), and 1.6 (0.3-2.6), respectively. Both iMAR and AiMAR had anatomicvisualization and artifact scores better than FBP (P < 0.001 for both) and similar to each other (P > 0.05). Structures with the most improvement in visualization score with the use of metal artifact reduction algorithms included theobturator internus muscle, internal and external iliac nodal chains, and vagina. iMAR and AiMAR improved diagnostic confidence (P < 0.001) and patient-level confidence in malignancy (P ≤ 0.24). For patients with hip prostheses and suspected bladder malignancy, the use of iMAR or AiMAR was shown to significantly reduce metal artifacts, thus improving diagnostic confidence and patient-level confidence in malignancy.

Direct Smear Versus Liquid-Based Cytology in the Diagnosis of Bladder Lesions.

Background & Objective:Urine cytology is an important diagnostic method for urinary tract cancers (especially carcinomas), which is suitable for follow-up of residual urothelial tumors after surgery of malignant bladder tumors. Liquid-based cytology (LBC) was used for the first time in cervical cytology Compared to direct smear cytology (DSC), LBC reduced background elements (including cellular debris, inflammatory cells, and blood cells), provided better cell preservation, and had a higher satisfaction rate. In this study, we performed two different methods (DSC and LBC) to detect bladder lesions; also, we determined the sensitivity and specificity of these methods. Methods:A total of 146 samples were taken from patients with suspected bladder cancer and processed for direct smear and LBC. In both methods, findings were reported according to the Paris System. Then, patients underwent cystoscopy and biopsy. Next, the accuracy of cytology methods was evaluated according to biopsy reports. The sensitivity and specificity of these methods were also calculated.Results:Credit indices obtained for the direct smear method included sensitivity (62.5%), specificity (89%), positive predictive value (89.5%), and negative predictive value (91.5%). For LBC methods, credit indices included sensitivity (85.7%), specificity (99%), positive predictive value (96%), and negative predictive value (96%). Agreement between the two methods was statistically significant (P<0.000) in negative biopsies but not in positive biopsies (P>0.05). Conclusion:This study showed that LBC has higher sensitivity and specificity than the direct smear.

Should National Institute for Clinical Excellence (NICE) Guidelines Remove Urine Cytology as a Suggested Adjunct in Suspected Bladder Cancer (haematuria) Investigations?

Background Despite National Institute for Clinical Excellence (NICE) guidelines suggesting the use of urine cytology (UC) for the diagnosis of bladder cancer, its use is variable. Reasons for this include sub-optimal sensitivity, financial cost, availability of alternative tests, and uncertainty over interpretation of results. Anecdotally, however, suspicious or malignant UC when other investigations are normal, occasionally leads to a cancer diagnosis. Therefore, we retrospectively assessed a cohort of our haematuria patients to determine the value of UC in cancer diagnosis and the clinical significance of atypical UC (graded as C3). Patients and methods We identified 3018 patients with haematuria referred on the suspected cancer pathway (“two-week wait”) in 2015. We retrospectively analysed clinical, demographic, and follow-up/outcome data in a random cohort of 500 cases. Results Median follow up was 58 months. Urological malignancy was diagnosed in 61/500 patients; all were identified by cystoscopy or imaging, i.e., irrespective of UC result. No cases of atypical UC re-presented with a ‘missed’ cancer diagnosis within the five-year follow-up period. However, suspicious and malignant cytology was associated with high-grade/aggressive tumours and subsequent tumour recurrence. Conclusion Urine cytology did not identify any cancers that were not already found by imaging or cystoscopy. Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for transurethral resection of bladder tumour (TURBT), however, it is unclear whether this might benefit patient outcomes. We conclude therefore that UC has no role in haematuria investigations.

1267 Utility of Artificial Intelligence in the Cystoscopic Detection of Bladder Cancer: A Systematic Review and Meta-Analysis

Abstract Aim Detection of suspected bladder cancer at diagnostic cystoscopy is challenging and is dependent on clinician skill. Artificial Intelligence (AI) algorithms, specifically, machine learning and deep learning, have shown promise in accurate classification of pathological images in various specialties. However, utility of AI for urothelial cancer diagnosis is unknown. Here, we aimed to systematically review the extant literature in this field and quantitively summarise the role of these algorithms in bladder cancer detection. Method The EMBASE, PubMed and CENTRAL databases were searched up to December 22nd 2020 , in accordance with the PRISMA guidelines, for studies that evaluated AI algorithms for cystoscopic diagnosis of bladder cancer. Random-effects meta-analysis was performed to summarise eligible studies. Risk of Bias was assessed using the QUADAS-2 tool. Results Five from 6715 studies met criteria for inclusion. Pooled sensitivity and specificity values were 0.93 (95% CI 0.89–0.95) and 0.93 (95% CI 0.80–0.89) respectively. Pooled positive likelihood and negative likelihood ratios were 14 (95% CI 4.3–44) and 0.08 (95% CI: 0.05–0.11), respectively. Pooled diagnostic odds ratio was 182 (95% CI 61–546). Summary AUC curve value was 0.95 (95% CI 0.93–0.97). No significant publication bias was noted. Conclusions In summary, AI algorithms performed very well in detection of bladder cancer in this pooled analysis, with high sensitivity and specificity values. However, as with other clinical AI usage, further external validation through deployment in real clinical situations is essential to assess true applicability of this novel technology.

Visual MRI T-category versus VI-RADS evaluation from multiparametric MRI in the detection of muscle-invasion in patients with suspected bladder cancer: single centre registered clinical trial (MIB-trial)

Background Multiparametric Magnetic Resonance Imaging (mpMRI) has been proposed to add value in the diagnostic pathway of bladder cancer (BC). We wanted to evaluate the performance of mpMRI for muscle-invasion detection in BC patients using a subjective MRI visual T-category and the Vesical Imaging-Reporting and Data System (VI-RADS) score. Methods This single centre clinical trial included 45 patients with suspected BC (ClinicalTrials.gov Identifier: NCT02662166). All patients had mpMRI prior to transurethral resection of bladder tumour (TUR-BT). The imaging was correlated to histopathological findings. Two individual radiologists evaluated all the mpMRI images. A binary cut-off point for the detection of muscle-invasion in the MRI visual T-category was defined between T1 and T2 and the VI-RADS cut-off score was 3. Cohen’s Kappa values were used to evaluate the agreement between the two radiologists. Sensitivity, Specificity, Area Under Receiver Operator Characteristics Curve (AUC), Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated to evaluate the performance of both radiologists separately. Results AUC values for reader A and B using the MRI visual T-category were 0.76 and 0.56, while the corresponding values for VI-RADS were 0.63 and 0.57, respectively. There was no statistically significant difference between the radiologists nor the reporting systems (p > .05) in the detection of muscle-invasion. The inter-reader agreement was substantial (0.61–0.80). Conclusion Both the subjective MRI visual T-category and VI-RADS score had only a low to moderate accuracy for the detection of muscle-invasion in BC with no statistically significant difference between the reporting systems.

A potential panel of five mRNAs in urinary extracellular vesicles for the detection of bladder cancer.

BackgroundExtracellular vesicles (EVs) have showed promising potential in liquid biopsy of cancer. In present study, we evaluate the feasibility to diagnose bladder cancer using EVs RNA markers identified from public tissue RNA sequencing data.MethodsWe used urine samples from a cohort of population with suspected bladder cancer. Disease status (i.e., primary or recurrent bladder cancer) was diagnosed by cystoscopy. A prediction model including the expression of multiple RNAs in urinary EVs were developed in training cohort (n=368, 126 bladder cancer and 242 negative controls). The performance of optimal model (ExoPanel) consists of five mRNAs (MYBL2, TK1, UBE2C, KRT7, S100A2) was further assessed by a validation cohort (n=155, 56 bladder cancer and 99 negative controls).ResultsThe performance of ExoPanel in training cohort was AUC 0.7759 (95% CI: 0.7259–0.8260), NPV 90.34% (95% CI: 84.04–94.42%), SN 88.89% (95% CI: 81.75–93.57%), and SP 54.13% (95% CI: 47.63–60.50%) respectively. In the validation cohort, the performance of this model was AUC 0.8402 (95% CI: 0.7690–0.9114), NPV 90.91% (95% CI: 79.29–96.60%), SN 91.07% (95% CI: 79.63–96.67%), and SP 50.51% (95% CI: 40.34–60.63%). Using this model, it is possible to rule out a significant number of non cancer patients, thus reduce the unnecessary operation of cystoscopy.ConclusionsWe discovered a panel of five mRNAs, and evaluated its potential to facilitate bladder cancer diagnosis by analyzing their expression in urinary EVs.

Cancer cell detection device for the diagnosis of bladder cancer from urine

Bladder cancer is common and has one of the highest recurrence rates. Cystoscopy, the current gold standard diagnosis approach, has recently benefited from the introduction of blue light assisted photodynamic diagnostic (PDD). While blue light cystoscopy improves diagnostic sensitivity, it remains a costly and invasive approach. Here, we present a microfluidic-based platform for non-invasive diagnosis which combines the principle of PDD with whole cell immunocapture technology to detect bladder cancer cells shed in patient urine ex vivo. Initially, we demonstrate with model cell lines that our non-invasive approach achieves highly specific capture rates of bladder cancer cells based on their Epithelial Cell Adhesion Molecule expression (>90%) and detection by the intensity levels of Hexaminolevulinic Acid-induced Protoporphyrin IX fluorescence. Then, we show in a pilot study that the biosensor platform successfully discriminates histopathologically diagnosed cancer patients (n = 10) from non-cancer controls (n = 25). Our platform can support the development of a novel non-invasive diagnostic device for post treatment surveillance in patients with bladder cancer and cancer detection in patients with suspected bladder cancer.

37-Year-Old Woman With Bilateral Lower Extremity Edema, Proteinuria, and Microscopic Hematuria

37-Year-Old Woman With Bilateral Lower Extremity Edema, Proteinuria, and Microscopic Hematuria

MP73-20 DIAGNOSTIC ACCURACY OF THE BI-PARAMETRIC MRI ANALYSIS FOR MUSCLE-INVASIVE BLADDER CANCER PREDICTION

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP73)1 Apr 2020MP73-20 DIAGNOSTIC ACCURACY OF THE BI-PARAMETRIC MRI ANALYSIS FOR MUSCLE-INVASIVE BLADDER CANCER PREDICTION Hyun Jung Jin* Hyun Jung Jin*Hyun Jung Jin* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000959.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate accuracy of the bi-parametric MRI (bpMRI) analysis using Vesical Imaging-Reporting and Data System (VI-RADS) for the prediction of muscle-invasive bladder cancer (MIBC). METHODS: In this retrospective study, a total of 100 patients who were suspected bladder cancer underwent bpMRI from May 2016 to March 2019. All bpMRI were retrospectively reviewed by one radiologist and scoring using the VI-RADS. Sensitivity, specificity and accuracy were calculated for each VI-RADS cutoff. The performance of bpMRI for the prediction of MIBC was analyzed using receiver operating characteristics (ROC) curves. RESULTS: Among the 100 patients, 81 patients were man and 19 patients were women, with the median age of 66.9 years (interquartile range [IQR], 60.0–76.0 years). Histopathological examination revealed 77 patients with non-muscle invasive bladder cancer (NMIBC) and 23 patients with MIBC. When the cutoff VIRADS ≥ 3 was used, sensitivity and specificity were 83% and 82%, and accuracy was 89%, respectively. The area under curve (AUC) on the ROC curve was 0.892 (95% confidence interval [CI] 0.814, 0.945). CONCLUSIONS: Analysis of bpMRI using the VI-RADS showed good accuracy in distinguishing NMIBC from MIBC. However, prospective and multi-institutional studies are needed to verify the validity of this study. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1129-e1130 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyun Jung Jin* More articles by this author Expand All Advertisement PDF downloadLoading ...

Bladder Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on the clinical presentation and workup of suspected bladder cancer, treatment of non-muscle-invasive urothelial bladder cancer, and treatment of metastatic urothelial bladder cancer because important updates have recently been made to these sections. Some important updates include recommendations for optimal treatment of non-muscle-invasive bladder cancer in the event of a bacillus Calmette-Guérin (BCG) shortage and details about biomarker testing for advanced or metastatic disease. The systemic therapy recommendations for second-line or subsequent therapies have also been revised. Treatment and management of muscle-invasive, nonmetastatic disease is covered in the complete version of the NCCN Guidelines for Bladder Cancer available at NCCN.org. Additional topics covered in the complete version include treatment of nonurothelial histologies and recommendations for nonbladder urinary tract cancers such as upper tract urothelial carcinoma, urothelial carcinoma of the prostate, and primary carcinoma of the urethra.

Urine Cytology as Seen in Uyo, Nigeria: How Relevant Is It to Medical Practice?

Aim:The aim of this study is to know the pattern of urine cytology (UC) requests seen in Uyo and how relevant they were to the management of the patients.Materials and Methods:This retrospective study was carried out in the Department of Pathology, University of Uyo Teaching Hospital. The extracted data from the cytology registers were analyzed using the Statistical Package for the Social Sciences version 17.Results:A total of 46 patients did UC during the period. The patients were aged between 21 years and 90 years, with a mean age of 56.89 ± 14.65. Thirty (67.4%) were male. The age group of 60–69 years accounted for most cases (37.8%). Suspicion of bladder cancer was the most common indication as it was seen in 28.9% (n = 13) of cases. Thirty-eight cases (84.4%) were referred from urology clinic, 2 each (4.4%) from general outpatient clinic, general surgery clinic, and from gynecology clinic. In 44.4% (n = 20) of cases, the cytological diagnosis was inflammatory smear, while the UC was normal in 24.4% (n = 11) cases. Malignant cells were seen in 11.1% of (n = 5) cases. Of the 13 cases that the indication was suspected bladder cancer, only four were positive for malignant cells and one was suspicious on UC. No malignant cell or suspicious cell was seen in any of the UC specimens from patients that had prostate cancer, lower urinary tract outlet obstruction with hematuria due to prostatic enlargement.Conclusion:UC should not be requested for in prostatic diseases since the reports are always negative or at most inflammatory. The department should start using The Paris System of UC reporting to assist the managing physician/surgeon to take the best decision.