Suspected Bladder Cancer Research Articles

Global Versus Indian Perspective of Pioglitazone-induced Adverse Drug Reactions Including Bladder Cancer: A Comparative Retrospective Pharmacovigilance Analysis

PurposeIn 2011, France and Germany banned pioglitazone due to a concomitant risk for bladder cancer. There has been continued debate about this topic. Therefore, we present a detailed analysis of data from individual case safety reports of pioglitazone use (PG-ICSRs) associated with bladder cancer reported worldwide and in India. MethodsData from PG-ICSRs reported by the National Coordination Centre's Pharmacovigilance Programme of India, as well as over 131 World Health Organization member countries in the Uppsala Monitoring Centre's VigiLyze pharmacovigilance database system, from January 1, 1967, to March 4, 2018, were collected. Comparisons between data from global and Indian PG-ICSRs were made by applying filters such as country, bladder cancer, age group, gender, time period, information component, and data mining. FindingsAmong the adverse drug reactions (ADRs) reported with pioglitazone use worldwide, bladder cancer and related terms were the most highly reported (43%). The most frequently co-reported concurrently used drug was metformin, which was included in 25% and 40% of overall and bladder cancer–specific PG-ICSRs, respectively. Suspected bladder cancer–specific pioglitazone-related reactions were reported in 27 countries, with 8548 serious and 1858 fatal cases and an information components value of 9.15. The Americas had the highest relative percentage of suspected bladder cancer in PG-ICSRs (53%), while the prevalence was much lower in India (2%). In both cohorts, men over the age of 45 years constituted the most highly reported population. ImplicationsIndia has a very low prevalence of reported overall and bladder cancer–specific pioglitazone-related ADRs compared to Europe and the Americas. Possible explanations for the difference in reporting rates include variance in genetic makeup, low BC risk factor, pioglitazone prescription at a lower therapeutic dose, greater use of chemopreventive spices in the diet, higher frequency of metformin as a concurrent drug, and under-reporting of ADRs.

Geographic Variation in Cystoscopy Rates for Suspected Bladder Cancer between Female and Male Medicare Beneficiaries

To assess geographic variation in cystoscopy rates among women vs men with suspected bladder cancer, lending insight into gender-specific differences in cystoscopic evaluation. We conducted a cross-sectional study of all fee-for-service Medicare beneficiaries within 306 Hospital Referral Regions (HRRs) who received care in 2014. For each HRR, we calculated the age- and race-adjusted cystoscopy rate for women and men as our primary outcome. The rate was the number of beneficiaries who underwent cystoscopy for bladder cancer symptoms (using procedure and ICD-9 diagnosis codes) divided by all beneficiaries in the HRR. We used the coefficient of variation to compare relative variability of cystoscopy rates. Overall, 173,551 women (n = 14.8 million) and 286,090 men (n = 11.5 million) underwent cystoscopy in 2014. While women received less cystoscopies compared to men (mean 11.0 vs 23.5 per 1000, P < .001), there was greater variation in cystoscopy rates among women (coefficient of variation 27.5 vs 23.5, P = .010). When restricting to ICD-9 codes for hematuria only, women continued to demonstrate greater variation in cystoscopy rates (coefficient of variation 27.8 vs 24.2, P = .022). Findings were robust across larger HRR sizes-thereby removing some random variation seen in smaller HRRs-as well as across years 2010, 2011, 2012, and 2013. Cystoscopy rates are lower in women than men, likely due to their lower bladder cancer incidence. However, there is greater variation in cystoscopy rates among women with symptoms of bladder cancer. This may reflect increased provider uncertainty whether to refer and work-up women with suspected bladder cancer.

The application of NICE guidelines in patients undergoing TURBT for suspected bladder cancer

The application of NICE guidelines in patients undergoing TURBT for suspected bladder cancer

Apparent diffusion coefficient values obtained by unenhanced MRI predicts disease-specific survival in bladder cancer

To assess the ability of apparent diffusion coefficient (ADC) measurements obtained by MRI to predict disease-specific survival (DSS) in patients with bladder cancer and compare it with established clinico-pathological prognostic factors. The ethical review board approved this cross-sectional study. Patients with suspected bladder cancer receiving diagnostic 3 T diffusion-weighted imaging (DWI) of the bladder before transurethral resection of the bladder (TUR-B) or radical cystectomy were evaluated prospectively. Two independent radiologists measured ADC values in bladder cancer lesions in regions of interest. Associations between ADC values and pathological features with DSS were tested statistically. A combined model was established using artificial neuronal network (ANN) methodology. A total of 51 patients (median age 69 years, range 41-89 years) were included. Three patients were lost to follow-up, leaving 48 patients for survival analysis. Seven patients died during the 795 months studied. ADC showed significant potential to predict DSS (p<0.05). Except for grading, all pathological features as assessed by TUR-B could predict DSS (p<0.05, respectively). The combined ANN classifier showed the highest accuracy to predict DSS (0.889, 95% confidence interval: 0.732-1, p=0.001) compared to all single parameters. ADC was the second important predictor of the ANN. ADC measurements obtained by unenhanced MRI predicts DSS in bladder cancer patients. A combined classifier including ADC and clinico-pathological information showed high accuracy to identify patients at high risk for disease-related death.

Spontaneous hypoglycaemia in an elderly man with suspected bladder cancer

Spontaneous hypoglycaemia in an elderly man with suspected bladder cancer

A case of chronic schistosomiasis four years after infestation

Authors present a case of bilharziosis incidentally diagnosed in a patient undergoing TURB for suspected bladder cancer. The patient, who in 2005 had gone to Malaysia, had been suffering from recurrent hemorrhagic cystitis since 2007, which were treated with antibiotic therapy. In November 2009 he presented to our observation for persistent hematuria, underwent ultrasound examination, fibroscopy and TURB diagnostics for suspicious lesions. The histopathology diagnosis found granulomatous lesions with typical parasites eggs due to schistosomiasis eggs. As a consequence of that, the patient underwent medical therapy. The pathologist's role becomes nullifying not only for the diagnosis of parasitic infections but also for the exclusion or evidence of urothelial squamous neoplasia. The low incidence of this rare parasitic disease in European tourists and the presence of immigrants in our country require to spread the knowledge of these parasites and the most simple tests for early detection.

MP08-06 COMBINATION OF RGB AND NARROW BAND IMAGING FOR DISCRIMINATION OF NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2017MP08-06 COMBINATION OF RGB AND NARROW BAND IMAGING FOR DISCRIMINATION OF NON-MUSCLE INVASIVE BLADDER CANCER Kwang Suk Lee, Kyo Chul Koo, Do Kyung Kim, Jongsoo Lee, Jong Won Kim, Jae Yong Jeong, Sung Ku Kang, and Byung Ha Chung Kwang Suk LeeKwang Suk Lee More articles by this author , Kyo Chul KooKyo Chul Koo More articles by this author , Do Kyung KimDo Kyung Kim More articles by this author , Jongsoo LeeJongsoo Lee More articles by this author , Jong Won KimJong Won Kim More articles by this author , Jae Yong JeongJae Yong Jeong More articles by this author , Sung Ku KangSung Ku Kang More articles by this author , and Byung Ha ChungByung Ha Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.293AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated the use of white light imaging (WLI) and narrow-band imaging (NBI) cystoscopy for the detection of bladder cancer. Additional objectives were to provide summary RGB data and to determine a relationship between cancer detection and tumor characteristics. METHODS A prospective double blinded controlled study of NBI was conducted in 102 consecutive patients with definite or suspected bladder cancer after WLI and NBI cystoscopy by 2 urologists. Transurethral targeted biopsies were performed and the histologic outcomes were compared. We analyzed average RGB color on 3x3 pixel of the randomized 3 other points for abnormal lesions and grossly normal in bladder. RESULTS A total of 172 biopsies for suspicious lesions (WLI+/NBI+=145, WLI-/NBI+=27) were taken. The percentage of malignancies in the sites identified only by NBI was 63.0% (17 sites).Of 15 CIS sites, 53.3% was detected by only NBI. The positive predictive value of NBI and WLI were 70.3% and 67.1%, respectively. Bladder washing cytology positive (HR=3.87, p=0.002). grossly papillary feature (HR=6.80, p<0.001) average blue of lesion for WLI (HR=0.96, p=0.006) were significant risk factors for detection of bladder cancer during transurethral targeted biopsy. CONCLUSIONS NBI is a simple and effective method for identifying CIS without the need for dyes. RGB analysis for bladder wall would be helpful for discrimination bladder cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e92 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kwang Suk Lee More articles by this author Kyo Chul Koo More articles by this author Do Kyung Kim More articles by this author Jongsoo Lee More articles by this author Jong Won Kim More articles by this author Jae Yong Jeong More articles by this author Sung Ku Kang More articles by this author Byung Ha Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Can diffusion-weighted MRI predict the histological grade of urinary bladder carcinoma?

Aim The aim of this study was to prospectively evaluate the ability of diffusion-weighted (DW) MRI in determining the T-stage of bladder cancer and to measure the correlation between the apparent diffusion coefficient and the histologic grade. Patients and methods Totally, 50 patients with suspected bladder cancer underwent MRI. These patients presented with gross (macroscopic) hematuria or had urinary bladder mass detected on ultrasound and/or computed tomography examinations. Human ethics committee approval for this study was obtained from the institutional review board of the hospital where these cases were treated. Two of 50 patients were excluded from the study because of technical difficulties or failure of data acquisition. All 48 patients underwent transurethral cystoscopic biopsy after imaging. Their MRI were read by two different radiologists who were blinded to the results of each other to minimize the bias. Results As regards the detection of urinary bladder carcinoma, DW-MRI showed an overall sensitivity of 100%, specificity of 75%, positive predictive value of 98%, negative predictive value of 100%, and accuracy of 98%. The sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using T2 images alone and combined use of T2 and diffusion-weighted images (DWIs) were 97, 64, and 88% and 100, 86, and 96%, respectively. The sensitivity, specificity, and accuracy for differentiating superficial from invasive tumors using postcontrast MRI alone and combined use of postcontrast MRI and DW images were 96, 71, and 91% and 100, 100, and 100%, respectively. In addition, we concluded that there is an inverse relationship between the mean apparent diffusion coefficient values and the histological grade of the tumor. Conclusion DW-MRI is a safe and confident method in the detection and local staging of urinary bladder carcinoma. In addition, DWIs may predict the histological grade of the tumor. Hence, DWI may be added to routine imaging protocols of urinary bladder tumors.

Preclinical study of bladder cancer diagnosis using tumor homing peptide fluorescent molecular probe

Objective To evaluate the features of optical molecular imaging of bladder tumor cells labeled by tumor homing peptide fluorescent molecular probe, and to explore the theoretical foundation of optical molecular imaging for bladder cancer diagnosis. Methods After prepared the FITC-CSNRDARRC fluorescent molecular probe, laser scanning confocal microscope, immuno fluorescence and multispectral fluorescence in vivo optical molecular imaging system have been used to evaluate the binding sites, the affecting factors of binding rates, the specificity and the targets. BIU-87 bladder tumor cell line, BIU-87 bladder tumor cell line, 68 cases of paraffin bladder tumor tissue samples, 16 cases of paraffin glandular bladder inflammatory samples, 43 cases of paraffin renal clear cell carcinoma samples, 68 cases of paraffin gastric adenocarcinoma samples, 29 cases of urine exfoliated cells suspected bladder cancer and BIU-87 bladder cancer nude xenograft have been used in this study. Results The binding site of FITC-CSNRDARRC fluorescent molecular probe were at the nucleus of labeled bladder tumor cells. The binding rates were correlated linearly with the dose of probe and the grade of pathology. The in vitro and in vivo studies demonstrate that the probe has a binding specificity with bladder tumor. When the FITC-CSNRDARRC fluorescent molecular probe labeled tumor cells, bright green spots were observed under laser scanning confocal microscope. The bright green spots were more apparent after stained by DAPI again. The tissue samples and tumor cells in the urine can be successful labeled and identified by fluorescence microscope. Optical molecular imaging of in vivo xenograft tumor tissues showed fluorescent spots under EMCCD. Conclusions The labeled loci of single cell by FITC-CSNRDARRC probe have been identified. The spatial resolution of optical molecular image is related to sensitivity of CCD, and the optical molecular imaging cannot be imaged by the conventional endoscope camera. Key words: Urinary bladder neoplasms; Tumor homing peptide; Fluorescent molecular probe; Optical molecular imaging; Molecule diagnosis

CAPABILITIES OF LIQUID CYTOLOGY IN THE DIAGNOSIS OF BLADDER CANCER

The study included 323 patients (the first group - 150 patients with suspected bladder cancer, the second - 173 patients with bladder cancer after treatment). All patients underwent cytological investigation of washings of bladder using conventional method and liquid cytology. This study presents comparative characteristics of these methods and shows considerable effectiveness of the method of liquid cytology in the diagnosis of bladder cancer and its local recurrence.

Local bladder cancer clusters in southeastern Michigan accounting for risk factors, covariates and residential mobility.

BackgroundIn case control studies disease risk not explained by the significant risk factors is the unexplained risk. Considering unexplained risk for specific populations, places and times can reveal the signature of unidentified risk factors and risk factors not fully accounted for in the case-control study. This potentially can lead to new hypotheses regarding disease causation.MethodsGlobal, local and focused Q-statistics are applied to data from a population-based case-control study of 11 southeast Michigan counties. Analyses were conducted using both year- and age-based measures of time. The analyses were adjusted for arsenic exposure, education, smoking, family history of bladder cancer, occupational exposure to bladder cancer carcinogens, age, gender, and race.ResultsSignificant global clustering of cases was not found. Such a finding would indicate large-scale clustering of cases relative to controls through time. However, highly significant local clusters were found in Ingham County near Lansing, in Oakland County, and in the City of Jackson, Michigan. The Jackson City cluster was observed in working-ages and is thus consistent with occupational causes. The Ingham County cluster persists over time, suggesting a broad-based geographically defined exposure. Focused clusters were found for 20 industrial sites engaged in manufacturing activities associated with known or suspected bladder cancer carcinogens. Set-based tests that adjusted for multiple testing were not significant, although local clusters persisted through time and temporal trends in probability of local tests were observed.ConclusionQ analyses provide a powerful tool for unpacking unexplained disease risk from case-control studies. This is particularly useful when the effect of risk factors varies spatially, through time, or through both space and time. For bladder cancer in Michigan, the next step is to investigate causal hypotheses that may explain the excess bladder cancer risk localized to areas of Oakland and Ingham counties, and to the City of Jackson.

Psychological distress in out-patients undergoing flexible cystoscopy for the investigation of bladder cancer

Objectives: Flexible cystoscopy can cause patients significant psychological distress, especially when utilised in the diagnostic pathway for suspected bladder cancer. We aimed to assess the prevalence of general anxiety and depression, as well as procedure-related worry and pain in patients undergoing local anaesthetic flexible cystoscopy and to determine whether these conditions occur more frequently in subsets of the population. Patients and methods: Patients referred for flexible cystoscopy were invited to participate. Patients were asked to complete a questionnaire containing the Hospital Anxiety and Depression Scale (HADS), a worry score and a question regarding the most stressful event in the diagnostic pathway. Following the procedure patients were also asked to complete a pain score. Results: A total of 175 patients participated in the study. The prevalence of significant anxiety was 15% and depression 3.5%. This was higher in younger, female and unmarried patients. Procedure-related worry and pain were generally low. Conclusions: We found the prevalence of anxiety and depression in patients undergoing flexible cystoscopy to be raised compared to a similar cohort of patients undergoing TRUS-guided prostate biopsy. We have identified subgroups more likely to experience these symptoms and have also identified the sections of the diagnostic pathway that are most likely to cause anxiety and depression. By doing this we can target those patients who are more likely to suffer during the diagnostic process and aim to improve their experience. We can also implement targeted changes to the pathway to reduce the impact it may have on patients’ mental health.

Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up

Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up

Feasible Method to enable clear visualization of suspected bladder cancer with 18F-FDG PET/CT

PurposeTo evaluate value of a new method in detecting bladder lesion with 18F-FDG PET/CT. MethodsRoutine and delayed scans of 14 patients were retrospectively studied. All these bladder lesions were confirmed by pathology. By increasing display threshold of SUVmax, routine images were analyzed for the second time. ResultsOf 12 18F-FDG-avid cases, 10 cases were confirmed to be primary bladder carcinoma, 2 false-positive cases were inflammation. There were 25% positive cases on routine display and 50% on display with increased SUVmax threshold. ConclusionThe method can effectively increase the sensitivity and accuracy in detecting bladder cancer with 18F-FDG PET/CT.

Incidence and Aetiology of Bladder Outlet Obstruction in Mangalore, Karnataka

Background and objective: Bladder outlet obstruction (BOO) is a blockage at the base of the bladder. BOO is a common cause of lower urinary tract symptoms in men and women. The condition is common in older men. Due to increased life expectancy there is an increased incidence of BOO. Thereby, we carried out a study to know the incidence of bladder outlet obstruction (BOO) in patients above 18 years attended in our institution along with the causative factors in them. Methods: A cross-sectional study was carried out among 100 adults. Ultrasound scan was the initial modality to diagnose BOO. X-ray KUB was used for bladder stones. Serum prostate specific antigen (PSA) and prostatic biopsy were done in cases of suspected carcinoma prostate. Cystoscopy was done in cases of suspected bladder cancer and bladder neck stenosis. Biopsy was taken in cases of bladder cancer. Results: Out of total of 100 cases in the age range 18–80 years, 53% had benign prostatic enlargement, 8% had carcinoma prostate, 14% had urethral tear, 7% had bladder cancer, 12% vesical calculus, 6% with bladder neck stenosis. In all, 94% cases were males and 6% females. Only the cases of bladder neck stenosis were females. Conclusion: This study highlights that BOO, a potentially curable illness commonly found in older men, benign prostatic hyperplasia (BPH) being the common cause. The key to successful treatment is in early diagnosis and treatment.

FTIR spectroscopy of biofluids revisited: an automated approach to spectral biomarker identification

The extraction of disease specific information from Fourier transform infrared (FTIR) spectra of human body fluids demands the highest standards of accuracy and reproducibility of measurements because the expected spectral differences between healthy and diseased subjects are very small in relation to a large background absorbance of the whole sample. Here, we demonstrate that with the increased sensitivity of modern FTIR spectrometers, automatisation of sample preparation and modern bioinformatics, it is possible to identify and validate spectral biomarker candidates for distinguishing between urinary bladder cancer (UBC) and inflammation in suspected bladder cancer patients. The current dataset contains spectra of blood serum and plasma samples of 135 patients. All patients underwent cytology and pathological biopsy characterization to distinguish between patients without UBC (46) and confirmed UBC cases (89). A minimally invasive blood test could spare control patients a repeated cystoscopy including a transurethral biopsy, and three-day stationary hospitalisation. Blood serum, EDTA and citrate plasma were collected from each patient and processed following predefined strict standard operating procedures. Highly reproducible dry films were obtained by spotting sub-nanoliter biofluid droplets in defined patterns, which were compared and optimized. Particular attention was paid to the automatisation of sample preparation and spectral preprocessing to exclude errors by manual handling. Spectral biomarker candidates were identified from absorbance spectra and their 1(st) and 2(nd) derivative spectra using an advanced Random Forest (RF) approach. It turned out that the 2(nd) derivative spectra were most useful for classification. Repeat validation on 21% of the dataset not included in predictor training with Linear Discriminant Analysis (LDA) classifiers and Random Forests (RFs) yielded a sensitivity of 93 ± 10% and a specificity of 46 ± 18% for bladder cancer. The low specificity can be most likely attributed to the unbalanced and small number of control samples. Using this approach, spectral biomarker candidates in blood-derived biofluids were identified, which allow us to distinguish between cancer and inflammation, but the observed differences were tiny. Obviously, a much larger sample number has to be investigated to reliably validate such candidates.

A Candidate Molecular Biomarker Panel for the Detection of Bladder Cancer

Bladder cancer is among the five most common malignancies worldwide, and due to high rates of recurrence, one of the most prevalent. Improvements in noninvasive urine-based assays to detect bladder cancer would benefit both patients and health care systems. In this study, the goal was to identify urothelial cell transcriptomic signatures associated with bladder cancer. Gene expression profiling (Affymetrix U133 Plus 2.0 arrays) was applied to exfoliated urothelia obtained from a cohort of 92 subjects with known bladder disease status. Computational analyses identified candidate biomarkers of bladder cancer and an optimal predictive model was derived. Selected targets from the profiling analyses were monitored in an independent cohort of 81 subjects using quantitative real-time PCR (RT-PCR). Transcriptome profiling data analysis identified 52 genes associated with bladder cancer (P ≤ 0.001) and gene models that optimally predicted class label were derived. RT-PCR analysis of 48 selected targets in an independent cohort identified a 14-gene diagnostic signature that predicted the presence of bladder cancer with high accuracy. Exfoliated urothelia sampling provides a robust analyte for the evaluation of patients with suspected bladder cancer. The refinement and validation of the multigene urothelial cell signatures identified in this preliminary study may lead to accurate, noninvasive assays for the detection of bladder cancer. The development of an accurate, noninvasive bladder cancer detection assay would benefit both the patient and health care systems through better detection, monitoring, and control of disease.

Nurse‐led flexible cystoscopy in Australia: initial experience and early results

• To present our initial experience implementing a nurse-led flexible cystoscopy (NLFC) service in a Victorian tertiary hospital and our initial results from that service, as NLFC has developed over the past decade with reports suggesting that adequately trained nurses can undertake FC competently. • We describe the implementation of a NLFC service including approval, funding, nurses' training, and protocols. • Outcomes of all patients having a NLFC or subsequent interventions were recorded prospectively and analysed retrospectively. • To gauge patients' response to NLFC, an anonymous feedback questionnaire was administered to 60 consecutive participating patients in the recovery unit. • The effect of NLFC on waiting times was determined from surgical scheduling records. • In all, 272 patients had 720 NLFC done over a 2-year period. In all, 150 (21%) FCs had a suspected bladder cancer recurrence and were referred for a rigid cystoscopy. Of those, 83 (58%) revealed a recurrence comprising of 14 (17%) high-grade lesions, 45 (54%) low-grade lesions and 24 (29%) were diathermied without a biopsy. In all, 41 (27%) had benign pathology on biopsy and 21 (14%) had normal rigid cystoscopy. • There were two significant adverse events. • There was a 65% reduction in the waiting list for surveillance FC after introduction of the service. • Of 60 patients who completed the feedback questionnaire, 95% reported that they were given enough information by the nurses, 92% had all their questions answered satisfactorily and 97% had enough confidence and trust in the nurse. In all, 90% had a positive perception of the service overall and 93% were happy to have a FC performed by a nurse rather than a doctor. • Results from our NLFC audit compare favourably with other published reports. NLFC is a safe and feasible option when established alongside strong departmental support, comprehensive nurses' training according to established guidelines, service supervision by a designated consultant and regular audits. • NLFC clinics can provide an efficient service and excellent continuity of care for patients with non-muscle-invasive bladder cancer.

Hexaminolevulinate-induced Fluorescence versus White Light During Transurethral Resection of Noninvasive Bladder Tumor: Does It Reduce Recurrences?

To evaluate the effect of hexaminolevulinate (HAL)-induced fluorescence during resection of noninvasive bladder cancer on tumor recurrence compared with resection under white light. Between 2008 and 2010, 102 consecutive patients with suspected bladder cancer were randomized to undergo transurethral resection with either conventional white light or combination of white light and HAL-induced fluorescence. Difference in tumor recurrence rate and recurrence-free survival between the 2 groups was evaluated. Subgroup analysis on recurrence-free survival was performed for different tumor parameters. Cystoscopy at 3 months revealed tumor recurrence in 6 of 45 (13.3%) patients of the white light group compared with only 1 of 41 patients of the HAL group (2.4%) (P < .001). The recurrence-free rates in white light patients at 12 and 18 months were 56.3% and 50.6%, respectively, compared with 91% and 82.5% in HAL patients (P = .0006). In subgroup analyses, recurrence-free survival was similar between the 2 groups when solitary tumors were treated (P = .3525). However, the HAL group had a favorable recurrence-free survival compared with the white light group when multifocal tumors (P < .001), primary tumors (P = .0237), recurrent tumors (P = .0189), nonaggressive (papillary urothelial neoplasm of low malignant potential and low grade) tumors (P = .0204), or aggressive (high grade and carcinoma in situ) tumors (P = .0134) were treated. HAL significantly aids resection of non-muscle-invasive bladder cancer with the result of reduction in tumor recurrence rates.

The diagnostic accuracy of multidetector computed tomography with multiplanar reformatted imaging and virtual cystoscopy in the early detection and evaluation of bladder carcinoma: comparison with conventional cystoscopy

To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) with multiplanar reformatted imaging and virtual cystoscopy (VC) in early detection and evaluation of bladder masses with comparison with conventional cystoscopic findings. This prospective study included 35 patients with suspected bladder cancer were studied by computed tomographic cystography (CTC) and virtual cystography (VC) in both the supine and prone positions after distending the bladder with air. The patient population was divided into three groups based on lesion size at conventional cystoscopy (CC). Results of the CT study were compared with those of CC. Sensitivity, specificity, positive, and negative predictive value was used to study the association between VC and CC as regarding lesion detection. The size of the tumors varied from 2 mm to occupying more than three quarters of the bladder. Of the 71 lesions detected on CC, 47 lesions were positive in histopathology, 28 were <4 mm (19 were positive and 9 were negative for neoplasia), and four of these were missed on VC, with one of 3 mm missed on CC and correctly located by VC. Thus, all lesions of >4 mm were detected by VC and 24 of 28 <4 mm. The locations of all were correctly described at VC when compared with CC. The overall sensitivity of VC vs. CC was 94.36%, specificity 71.42%, PPV was 97.1%, and NPV was 55.55%. Cystoscopy remains the standard of reference for the evaluation of the urinary bladder, but MDCT is indicated for examination of patients on whom CC is contraindicated, difficult to perform, unsatisfactory in interpretation, and as an adjuvant tool in the evaluation of areas difficult to assess with CC.