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Imaging in Localized Bladder Cancer: Can Current Diagnostic Modalities Provide Accurate Local Tumor Staging?

  • New Imaging Techniques (S Rais-Bahrami and K Porter, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Local tumor staging is paramount in the evaluation and management of bladder cancer. While neoadjuvant chemotherapy (NAC) followed by radical cystectomy and urinary diversion remains the gold standard for management of muscle-invasive bladder cancer, bladder-sparing regimens involving systemic chemotherapy and pelvic radiotherapy remain a viable option for select patients. Moreover, pre-cystectomy identification of patients with a complete response to NAC may obviate the need for radical cystectomy, but accurate post-therapy staging can be difficult to achieve. Contemporary imaging techniques may provide additional benefit in local tumor staging beyond standard imaging and cystoscopic biopsy. Our purpose is to summarize the ability of different imaging modalities to accurately stage bladder cancer patients in the treatment-naïve and post-chemotherapy settings.

Recent Findings

Contemporary investigations have been studying multiparametric magnetic resonance imaging (mp-MRI) in the evaluation of bladder cancer. Its recent incorporation into bladder cancer staging is mainly being assessed in treatment-naïve patients; however, different sequences are being studied to assess their accuracy after the introduction of chemotherapy and possibly radiation. Multiple recent studies incorporating cystoscopy and biopsy are proving to be less accurate than originally predicted.

Summary

Imaging has generally had a very limited role in guiding therapy in localized bladder cancer, but with the incorporation of newer sequences and techniques, imaging is poised to become vital in decision-making strategies of this cancer. Reliable local tumor staging through improved imaging may help better select patients for bladder-sparing treatments while maintaining optimized oncologic outcomes and allow this paradigm to become more acceptable in the urologic oncology community.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.

    Article  PubMed  Google Scholar 

  2. Yeung C, Dinh T, Lee J. The health economics of bladder cancer: an updated review of the published literature. Pharmacoeconomics. 2014;32(11):1093–104.

    Article  PubMed  Google Scholar 

  3. Waingankar N, Mallin K, Smaldone M, Egleston BL, Higgins A, Winchester DP, et al. Assessing the relative influence of hospital and surgeon volume on short-term mortality after radical cystectomy. BJU Int. 2017;120(2):239–45.

    Article  PubMed  Google Scholar 

  4. Efstathiou JA, Spiegel DY, Shipley WU, Heney NM, Kaufman DS, Niemierko A, et al. Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. Eur Urol. 2012;61(4):705–11.

    Article  Google Scholar 

  5. Advanced Bladder Cancer Meta-analysis C. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol. 2005;48(2):202–5 discussion 205-206.

    Article  Google Scholar 

  6. Mazza P, Moran GW, Li G, Robins DJ, Matulay JT, Herr HW, et al. Conservative management following complete clinical response to neoadjuvant chemotherapy of muscle invasive bladder cancer: contemporary outcomes of a multi-institutional cohort study. J Urol. 2018;200(5):1005–13.

    Article  PubMed  Google Scholar 

  7. Nicolau C, Bunesch L, Peri L, Salvador R, Corral JM, Mallofre C, et al. Accuracy of contrast-enhanced ultrasound in the detection of bladder cancer. Br J Radiol. 2011;84(1008):1091–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Stamatiou K, Papadoliopoulos I, Dahanis S, Zafiropoulos G, Polizois K. The accuracy of ultrasonography in the diagnosis of superficial bladder tumors in patients presenting with hematuria. Ann Saudi Med. 2009;29(2):134–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Drudi FM, Di Leo N, Malpassini F, Antonini F, Corongiu E, Iori F. CEUS in the differentiation between low and high-grade bladder carcinoma. J Ultrasound. 2012;15(4):247–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Li Q, Tang J, He E, Li Y, Zhou Y, Wang B. Differentiation between high- and low-grade urothelial carcinomas using contrast enhanced ultrasound. Oncotarget. 2017;8(41):70883–9.

    PubMed  PubMed Central  Google Scholar 

  11. Kocakoc E, Kiris A, Orhan I, Poyraz AK, Artas H, Firdolas F. Detection of bladder tumors with 3-dimensional sonography and virtual sonographic cystoscopy. J Ultrasound Med. 2008;27(1):45–53.

    Article  PubMed  Google Scholar 

  12. Wang LJ, Wong YC, Ng KF, Chuang CK, Lee SY, Wan YL. Tumor characteristics of urothelial carcinoma on multidetector computerized tomography urography. J Urol. 2010;183(6):2154–60.

    Article  PubMed  Google Scholar 

  13. Martingano P, Stacul F, Cavallaro M, Casagrande F, Cernic S, Belgrano M, et al. 64-Slice CT urography: 30 months of clinical experience. Radiol Med. 2010;115(6):920–35.

    Article  CAS  PubMed  Google Scholar 

  14. Helenius M, Brekkan E, Dahlman P, Lonnemark M, Magnusson A. Bladder cancer detection in patients with gross haematuria: computed tomography urography with enhancement-triggered scan versus flexible cystoscopy. Scand J Urol. 2015;49(5):377–81.

    Article  Google Scholar 

  15. Qu X, Huang X, Wu L, Huang G, Ping X, Yan W. Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: a meta-analysis. Eur J Radiol. 2011;80(2):188–97.

    Article  PubMed  Google Scholar 

  16. •• Panebianco V, Narumi Y, Altun E, et al. Multiparametric magnetic resonance imaging for bladder cancer: development of VI-RADS (vesical imaging-reporting and data system). Eur Urol. 2018;74(3):294–306 This is the original article which discusses the creation and details of the VI-RADS system. It outlines each section of the scoring system and illustrates them with examples.

  17. Rabie E, Faeghi F, Izadpanahi MH, Dayani MA. Role of dynamic contrast-enhanced magnetic resonance imaging in staging of bladder cancer. J Clin Diagn Res. 2016;10(4):TC01–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Yoshida S, Koga F, Kobayashi S, Tanaka H, Satoh S, Fujii Y, et al. Diffusion-weighted magnetic resonance imaging in management of bladder cancer, particularly with multimodal bladder-sparing strategy. World J Radiol. 2014;6(6):344–54.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ueno Y, Takeuchi M, Tamada T, Sofue K, Takahashi S, Kamishima Y, et al. Diagnostic accuracy and interobserver agreement for the vesical imaging-reporting and data system for muscle-invasive bladder cancer: a multireader validation study. Eur Urol. 2019;76:54–6.

    Article  PubMed  Google Scholar 

  20. Wang H, Luo C, Zhang F, et al. Multiparametric MRI for bladder cancer: validation of VI-RADS for the detection of detrusor muscle invasion. Radiology. 2019;291(3):668–74.

    Article  PubMed  Google Scholar 

  21. Barchetti G, Simone G, Ceravolo I, Salvo V, Campa R, del Giudice F, et al. Multiparametric MRI of the bladder: inter-observer agreement and accuracy with the vesical imaging-reporting and data system (VI-RADS) at a single reference center. Eur Radiol. 2019;29:5498–506.

    Article  PubMed  Google Scholar 

  22. Nishimura K, Fujiyama C, Nakashima K, Satoh Y, Tokuda Y, Uozumi J. The effects of neoadjuvant chemotherapy and chemo-radiation therapy on MRI staging in invasive bladder cancer: comparative study based on the pathological examination of whole layer bladder wall. Int Urol Nephrol. 2009;41(4):869–75.

    Article  CAS  PubMed  Google Scholar 

  23. Schrier BP, Peters M, Barentsz JO, Witjes JA. Evaluation of chemotherapy with magnetic resonance imaging in patients with regionally metastatic or unresectable bladder cancer. Eur Urol. 2006;49(4):698–703.

    Article  CAS  PubMed  Google Scholar 

  24. Donaldson SB, Bonington SC, Kershaw LE, Cowan R, Lyons J, Elliott T, et al. Dynamic contrast-enhanced MRI in patients with muscle-invasive transitional cell carcinoma of the bladder can distinguish between residual tumour and post-chemotherapy effect. Eur J Radiol. 2013;82(12):2161–8.

    Article  PubMed  Google Scholar 

  25. Chakiba C, Cornelis F, Descat E, Gross-Goupil M, Sargos P, Roubaud G, et al. Dynamic contrast enhanced MRI-derived parameters are potential biomarkers of therapeutic response in bladder carcinoma. Eur J Radiol. 2015;84(6):1023–8.

    Article  PubMed  Google Scholar 

  26. Yoshida S, Koga F, Kobayashi S, et al. Role of diffusion-weighted magnetic resonance imaging in predicting sensitivity to chemoradiotherapy in muscle-invasive bladder cancer. Int J Radiat Oncol Biol Phys. 2012;83(1):e21–7.

    Article  PubMed  Google Scholar 

  27. Yoshida S, Koga F, Kawakami S, Ishii C, Tanaka H, Numao N, et al. Initial experience of diffusion-weighted magnetic resonance imaging to assess therapeutic response to induction chemoradiotherapy against muscle-invasive bladder cancer. Urology. 2010;75(2):387–91.

    Article  PubMed  Google Scholar 

  28. Mansour AM, Soloway MS, Eldefrawy A, Singal R, Joshi S, Manoharan M. Prognostic significance of cystoscopy findings following neoadjuvant chemotherapy for muscle-invasive bladder cancer. Can J Urol. 2015;22(2):7690–7.

    PubMed  Google Scholar 

  29. Zargar H, Zargar-Shoshtari K, Lotan Y, Shah JB, van Rhijn B, Daneshmand S, et al. Final pathological stage after neoadjuvant chemotherapy and radical cystectomy for bladder cancer-does pT0 predict better survival than pTa/Tis/T1? J Urol. 2016;195(4 Pt 1):886–93.

    Article  CAS  PubMed  Google Scholar 

  30. Meyer A, Brant A, Nichols P, Kates M, Reese A, Hahn N, et al. Inaccuracy of clinical staging after neoadjuvant chemotherapy for muscle invasive bladder cancer. J Urol. 2018;199.

  31. • Asghar A, Parker D, McGowan T, et al. Prospective evaluation of cystoscopy and bladder mapping reveals nearly a 30% miss rate for pT2 pathology. J Urol. 2019;201(Supplement 4):e1194 These two recently presented abstracts give us much better information about the limitations of cystoscopy and biopsy in determining the response to neoadjuvent chemotherapy.

  32. Fukui T, Matsui Y, Umeoka S, Inoue T, Kamba T, Togashi K, et al. Predictive value of radiological response rate for pathological response to neoadjuvant chemotherapy and post-cystectomy survival of bladder urothelial cancer. Jpn J Clin Oncol. 2016;46:560–7.

    Article  Google Scholar 

  33. Soubra A, Gencturk M, Froelich J, Balaji P, Gupta S, Jha G, et al. FDG-PET/CT for assessing the response to neoadjuvant chemotherapy in bladder cancer patients. Clin Genitourin Cancer. 2018;16(5):360–4.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported in part by the Intramural Research Program of the National Cancer Institute, NIH.

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Authors and Affiliations

  1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Building 10, Room 1-5940 W, Bethesda, MD, 20892, USA

    Sandeep Gurram

  2. Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, USA

    Akhil Muthigi, Jillian Egan & Lambros Stamatakis

  3. Department of Urology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC, 20010, USA

    Lambros Stamatakis

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  1. Sandeep Gurram
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  2. Akhil Muthigi
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  3. Jillian Egan
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  4. Lambros Stamatakis
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Correspondence to Lambros Stamatakis.

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Sandeep Gurram, Akhil Muthigi, Jillian Egan, and Lambros Stamatakis each declare no potential conflicts of interest.

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Gurram, S., Muthigi, A., Egan, J. et al. Imaging in Localized Bladder Cancer: Can Current Diagnostic Modalities Provide Accurate Local Tumor Staging?. Curr Urol Rep 20, 82 (2019). https://doi.org/10.1007/s11934-019-0948-7

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  • DOI: https://doi.org/10.1007/s11934-019-0948-7

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