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Bladder cancer local staging: multiparametric MRI performance following transurethral resection

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Abstract

Purpose

To evaluate the performance of multiparametric MRI (mpMRI) for the local staging of bladder cancer following transurethral resection of bladder tumor.

Methods

This Institutional Review Board-approved, retrospective study identified 45 patients with pathology-proven bladder cancer who underwent transurethral resection followed by mpMRI between August 2011 and October 2016. Two radiologists reviewed each MRI independently and assigned T and N stage. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the presence of muscle invasion (T2 or higher), peri-vesical invasion (T3 or higher), and regional nodal disease compared to findings at cystectomy as the reference standard. Inter-observer agreement was measured using Cohen’s κ coefficient.

Results

Of 45 patients, 13% were stage T2, 27% T3, 16% T4; of 40 patients, 28% had regional nodal disease. Sensitivity, specificity, PPV, NPV, and accuracy of mpMRI for readers 1 and 2, respectively, were muscle invasion, 92% and 88%, 74% and 84%, 81% and 88%, 88% and 84%, 84% and 86%; peri-vesical invasion, 72% and 67%, 92% and 92%, 87% and 86%, 81% and 79%, 83% and 81%; regional nodal disease, 45% and 45%, 93% and 90%, 71% and 63%, 82% and 81%, 80% and 78%. Inter-observer agreement was good using all sequences.

Conclusions

mpMRI was both sensitive and specific in the detection of muscle invasive bladder cancer, and was specific but not sensitive for both peri-vesical invasion and nodal involvement. mpMRI may have a role at locally staging bladder cancer following transurethral resection.

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References

  1. National Cancer Institute (2017) SEER Stat Fact Sheets: Bladder Cancer. http://seer.cancer.gov/statfacts/html/urinb.html. Accessed 5 May 2017

  2. Nielsen ME, Smith AB, Pruthi RS, et al. (2012) Reported use of intravesical therapy for non-muscle-invasive bladder cancer (NMIBC): results from the Bladder Cancer Advocacy Network (BCAN) survey. BJU Int 110(7):967–972. https://doi.org/10.1111/j.1464-410x.2012.11060.x

    Article  PubMed  Google Scholar 

  3. Fedeli U, Fedewa SA, Ward EM (2011) Treatment of muscle invasive bladder cancer: evidence from the National Cancer Database, 2003 to 2007. J Urol 185(1):72–78. https://doi.org/10.1016/j.juro.2010.09.015

    Article  PubMed  Google Scholar 

  4. Babjuk M (2009) Transurethral resection of non-muscle-invasive bladder cancer. Eur Urol Suppl 8:542–548

    Article  Google Scholar 

  5. Shariat SF, Palapattu GS, Karakiewicz PI, et al. (2007) Discrepancy between clinical and pathologic stage: impact on prognosis after radical cystectomy. Eur Urol 51 (1):137–149; discussion 149–151. https://doi.org/10.1016/j.eururo.2006.05.021

  6. Dutta SC, Smith JA Jr, Shappell SB, et al. (2001) Clinical under staging of high risk nonmuscle invasive urothelial carcinoma treated with radical cystectomy. J Urol 166(2):490–493

    Article  PubMed  CAS  Google Scholar 

  7. Huang J, Fu J, Zhan H, et al. (2012) Analysis of the absence of the detrusor muscle in initial transurethral resected specimens and the presence of residual tumor tissue. Urol int 89(3):319–325. https://doi.org/10.1159/000341103

    Article  PubMed  Google Scholar 

  8. Han KS, Joung JY, Cho KS, et al. (2008) Results of repeated transurethral resection for a second opinion in patients referred for nonmuscle invasive bladder cancer: the referral cancer center experience and review of the literature. J Endourol/Endourol Soc 22(12):2699–2704. https://doi.org/10.1089/end.2008.0281

    Article  Google Scholar 

  9. Schwaibold HE, Sivalingam S, May F, Hartung R (2006) The value of a second transurethral resection for T1 bladder cancer. BJU Int 97(6):1199–1201. https://doi.org/10.1111/j.1464-410x.2006.06144.x

    Article  PubMed  Google Scholar 

  10. Richards KA, Smith ND, Steinberg GD (2014) The importance of transurethral resection of bladder tumor in the management of nonmuscle invasive bladder cancer: a systematic review of novel technologies. J Urol 191(6):1655–1664. https://doi.org/10.1016/j.juro.2014.01.087

    Article  PubMed  Google Scholar 

  11. National Comprehensive Cancer Network (2017) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ): Bladder Cancer (Version 2.2017). https://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf. Accessed 7 May 2017

  12. Chang SS, Boorjian SA, Chou R, et al. (2016) Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol 196(4):1021–1029. https://doi.org/10.1016/j.juro.2016.06.049

    Article  PubMed  Google Scholar 

  13. McInnes MD, Siemens DR, Mackillop WJ, et al. (2016) Utilisation of preoperative imaging for muscle-invasive bladder cancer: a population-based study. BJU Int 117(3):430–438. https://doi.org/10.1111/bju.13034

    Article  PubMed  Google Scholar 

  14. Tekes A, Kamel I, Imam K, et al. (2005) Dynamic MRI of bladder cancer: evaluation of staging accuracy. Am J Roentgenol 184(1):121–127. https://doi.org/10.2214/ajr.184.1.01840121

    Article  Google Scholar 

  15. Babjuk M, Bohle A, Burger M, et al. (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71(3):447–461. https://doi.org/10.1016/j.eururo.2016.05.041

    Article  PubMed  Google Scholar 

  16. Rabie E, Faeghi F, Izadpanahi MH, Dayani MA (2016) Role of dynamic contrast-enhanced magnetic resonance imaging in staging of bladder cancer. J Clin Diagn Res 10(4):Tc01–Tc05. https://doi.org/10.7860/jcdr/2016/17596.7690

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Daneshmand S, Ahmadi H, Huynh LN, Dobos N (2012) Preoperative staging of invasive bladder cancer with dynamic gadolinium-enhanced magnetic resonance imaging: results from a prospective study. Urology 80(6):1313–1318. https://doi.org/10.1016/j.urology.2012.07.056

    Article  PubMed  Google Scholar 

  18. Rajesh A, Sokhi HK, Fung R, Mulcahy KA, Bankart MJ (2011) Bladder cancer: evaluation of staging accuracy using dynamic MRI. Clin Radiol 66(12):1140–1145. https://doi.org/10.1016/j.crad.2011.05.019

    Article  PubMed  CAS  Google Scholar 

  19. Gupta N, Sureka B, Kumar MM, et al. (2015) Comparison of dynamic contrast-enhanced and diffusion weighted magnetic resonance image in staging and grading of carcinoma bladder with histopathological correlation. Urol Ann 7(2):199–204. https://doi.org/10.4103/0974-7796.150480

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wang HJ, Pui MH, Guo Y, et al. (2015) Multiparametric 3-T MRI for differentiating low- versus high-grade and category T1 versus T2 bladder urothelial carcinoma. Am J Roentgenol 204(2):330–334. https://doi.org/10.2214/ajr.14.13147

    Article  Google Scholar 

  21. de Haas RJ, Steyvers MJ, Futterer JJ (2014) Multiparametric MRI of the bladder: ready for clinical routine? Am J Roentgenol 202(6):1187–1195. https://doi.org/10.2214/ajr.13.12294

    Article  Google Scholar 

  22. Takeuchi M, Sasaki S, Ito M, et al. (2009) Urinary bladder cancer: diffusion-weighted MR imaging—accuracy for diagnosing T stage and estimating histologic grade. Radiology 251(1):112–121. https://doi.org/10.1148/radiol.2511080873

    Article  PubMed  Google Scholar 

  23. Thoeny HC, Froehlich JM, Triantafyllou M, et al. (2014) Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology 273(1):125–135. https://doi.org/10.1148/radiol.14132921

    Article  PubMed  Google Scholar 

  24. Amin M, Edge S, Greene F, et al. (2017) AJCC Cancer Staging Manual, 8th edn. New York: Springer

    Book  Google Scholar 

  25. R Core Team (2017) A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. https://www.r-project.org/

  26. Revelle W (2015) Psych: Procedures for Personality and Psychological Research. Evanston: Northwestern University. http://cran.r-project.org/package=psych Version = 1.5.6

  27. Yoshida S, Takahara T, Kwee TC, et al. (2017) DWI as an imaging biomarker for bladder cancer. Am J Roentgenol . https://doi.org/10.2214/ajr.17.17798

    Article  Google Scholar 

  28. Nishimura K, Fujiyama C, Nakashima K, et al. (2009) 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 41(4):869–875. https://doi.org/10.1007/s11255-009-9566-5

    Article  PubMed  CAS  Google Scholar 

  29. Lee CH, Tan CH, Faria SC, Kundra V (2017) Role of imaging in the local staging of urothelial carcinoma of the bladder. Am J Roentgenol . https://doi.org/10.2214/ajr.16.17114

    Article  Google Scholar 

  30. Kim B, Semelka RC, Ascher SM, et al. (1994) Bladder tumor staging: comparison of contrast-enhanced CT, T1- and T2-weighted MR imaging, dynamic gadolinium-enhanced imaging, and late gadolinium-enhanced imaging. Radiology 193(1):239–245. https://doi.org/10.1148/radiology.193.1.8090898

    Article  PubMed  CAS  Google Scholar 

  31. Watanabe H, Kanematsu M, Kondo H, et al. (2009) Preoperative T staging of urinary bladder cancer: does diffusion-weighted MRI have supplementary value? Am J Roentgenol 192(5):1361–1366. https://doi.org/10.2214/ajr.08.1430

    Article  Google Scholar 

  32. Thoeny HC, Ross BD (2010) Predicting and monitoring cancer treatment response with diffusion-weighted MRI. J Magn Reson Imaging 32(1):2–16. https://doi.org/10.1002/jmri.22167

    Article  PubMed  PubMed Central  Google Scholar 

  33. Panebianco V, De Berardinis E, Barchetti G, et al. (2017) An evaluation of morphological and functional multi-parametric MRI sequences in classifying non-muscle and muscle invasive bladder cancer. Eur Radiol . https://doi.org/10.1007/s00330-017-4758-3

    Article  PubMed  Google Scholar 

  34. Wang HJ, Pui MH, Guan J, et al. (2016) Comparison of early submucosal enhancement and tumor stalk in staging bladder urothelial carcinoma. Am J Roentgenol . https://doi.org/10.2214/ajr.16.16283

    Article  Google Scholar 

  35. Kobayashi S, Koga F, Yoshida S, et al. (2011) Diagnostic performance of diffusion-weighted magnetic resonance imaging in bladder cancer: potential utility of apparent diffusion coefficient values as a biomarker to predict clinical aggressiveness. Eur Radiol 21(10):2178–2186. https://doi.org/10.1007/s00330-011-2174-7

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Christian B. van der Pol, Sree Harsha Tirumani & Stuart G. Silverman

  2. Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA

    Atul B. Shinagare

  3. Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, 45 Francis St, ASBII-3, Boston, MA, 02115, USA

    Mark A. Preston

  4. Massachusetts General Hospital, Harvard Medical School, Radiology/CNY149-Rm 2301, 149 13th St, Charlestown, MA, 02129, USA

    Mark G. Vangel

Authors
  1. Christian B. van der Pol
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  3. Sree Harsha Tirumani
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Corresponding author

Correspondence to Atul B. Shinagare.

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Funding

No funding was provided for this study.

Conflict of interest

Dr. Atul B. Shinagare is a consultant for Arog Pharmaceuticals, and receives research funding from GTx, Inc. Christian B. van der Pol, Sree Harsha Tirumani, Mark A. Preston, Mark G. Vangel, Stuart G. Silverman declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This retrospective image review study was approved by the Institution Review Board with a waiver of informed consent for retrospective image analysis.

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van der Pol, C.B., Shinagare, A.B., Tirumani, S.H. et al. Bladder cancer local staging: multiparametric MRI performance following transurethral resection. Abdom Radiol 43, 2412–2423 (2018). https://doi.org/10.1007/s00261-017-1449-0

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