Study Type
Study Type
Study Objective(Purpose of Study)
Study Objective(Purpose of Study)
Study Results
Study Results
Study Quality
Study Quality
1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11-30. Review/Other-Tx N/A To provide the expected numbers of new cancer cases and deaths in 2013 nationally and by state, as well as an overview of current cancer statistics using data through 2009, including incidence, mortality, and survival rates and trends. The article also estimate the total number of deaths averted as a result of the decline in cancer death rates since the early 1990s, and provide the actual reported numbers of deaths in 2009 by age for the 10 leading causes of death and the 5 leading cancer types. In 2009, Americans had a 20% lower risk of death from cancer than in 1991, when cancer death rates peaked. Despite this substantial progress, all demographic groups have not benefitted equally, particularly for cancers such as colorectal and breast, for which mortality declines have been attributed to earlier detection and improvements in treatment. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket as well as other disadvantaged populations. 4
2. American Cancer Society. Survival rates for bladder cancer by stage. Available at: Accessed 4 February 2013. Review/Other-Tx N/A To review survival rates of bladder cancer. N/A 4
3. Sengupta S, Blute ML. The management of superficial transitional cell carcinoma of the bladder. Urology. 2006; 67(3 Suppl 1):48-54; discussion 54-45. Review/Other-Tx N/A To review the staging, management, and surveillance of superficial bladder cancer. The optimal management of patients with superficial bladder cancer depends on risk-group stratification. 4
4. Volkmer BG, Kuefer R, Bartsch GC, Jr., Gust K, Hautmann RE. Oncological followup after radical cystectomy for bladder cancer-is there any benefit? J Urol. 2009;181(4):1587-1593; discussion 1593. Observational-Tx 1270 patients Data on a large, single center cystectomy series was analyzed to determine the value of standardized followup examinations. The 20-year recurrence rate was 48.6% in the complete series. Tumor recurrence developed in 444 patients, including 154 asymptomatic and 290 symptomatic patients, with a mean time after radical cystectomy of 20 and 17.5 months, respectively. The most frequent symptoms were pain, ileus, acute urinary retention, hydronephrosis with flank pain, hematuria, neurological symptoms and a palpable mass. Of the 444 patients 182 (41%) had local recurrence and 324 (73%) had distant failure at the time of first recurrence. The overall survival rate 1, 2 and 5 years after first recurrence was 22.5%, 10.1% and 5.5% in asymptomatic patients, and 18.9%, 8.2% and 2.9% in symptomatic patients, respectively (log rank not significant). 2
5. Yan Y, Andriole GL, Humphrey PA, Kibel AS. Patterns of multiple recurrences of superficial (Ta/T1) transitional cell carcinoma of bladder and effects of clinicopathologic and biochemical factors. Cancer. 2002; 95(6):1239-1246. Observational-Tx 270 patients To describe multiple sequential recurrence patterns among superficial bladder carcinoma patients and identify clinicopathologic and biochemical factors associated with the patterns. Among the 270 patients, 126 (46.7%) had one or more recurrences, 38 (14.1%) had two or more recurrences, and 14 (5.2%) had three or more recurrences during the follow-up. The median times for the first, the second, and the third recurrences were 23 months, 15 months, and 13 months, respectively. In Kaplan-Meier analysis, stage T1, higher grades, and Ki-67 stain positivity were associated with the first recurrence, and p53 stain positivity was marginally significant. Other markers were not significant. For the second recurrence, only p53 stain positivity was significant. In multivariate analysis (Wei, Lin, and Weissfeld method), stage was significantly associated with the first recurrence (risk ratio = 2.03), and Ki-67 was marginally significant (risk ratio = 1.49). For the second recurrence, only p53 positivity was statistically significant (risk ratio = 2.73). 2
6. Stein JP, Lieskovsky G, Cote R, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001; 19(3):666-675. Observational-Tx 1,054 patients To evaluate the long-term outcome of patients treated with radical cystectomy and lymph node dissection and to describe the association of the primary bladder tumor stage and regional lymph node status with clinical outcomes. Median follow-up was 10.2 years. The median time to recurrence among patients in whom the cancer recurred was 12 months. In 22% there was a distant recurrence, and in 7% there was a local (pelvic) recurrence. Data support aggressive surgical management of invasive bladder cancer. 2
7. Malkowicz SB, van Poppel H, Mickisch G, et al. Muscle-invasive urothelial carcinoma of the bladder. Urology. 2007; 69(1 Suppl):3-16. Review/Other-Tx N/A Review of treatment, outcome, and follow-up of patients with muscle invasive bladder cancer. Radical cystectomy remains the “gold-standard” of therapy, although organ-sparing procedures demonstrate clinical effectiveness as well. Pelvic lymph node dissection should be performed when possible. 4
8. Ghoneim MA, Abdel-Latif M, el-Mekresh M, et al. Radical cystectomy for carcinoma of the bladder: 2,720 consecutive cases 5 years later. J Urol. 2008; 180(1):121-127. Observational-Tx 2,720 patients To assess the results of radical cystectomy in patients with invasive bladder cancer. Follow-up ranged from 0 to 34.2 years with a mean of 5.5 +/- 5.7. Radical cystectomy for muscle invasive bladder cancer was associated with a 50% to 60% 5-year survival. Tumor stage, histological grade, and lymph node status had a significant and independent impact on survival. 3
9. Herrmann E, Stoter E, van Ophoven A, et al. The prognostic impact of pelvic lymph node metastasis and lymphovascular invasion on bladder cancer. Int J Urol. 2008; 15(7):607-611. Observational-Tx 614 patients To present long-term results of a single-center series of patients undergoing bilateral pelvic lymphadenectomy and radical cystectomy for bladder cancer and to analyze the impact of pelvic lymph node metastasis and lymphovascular invasion on clinical outcome. Disease-free and OS in the entire cohort was 56.7% and 49.5% at 5 years and 52.4% and 38.2% at 10 years, respectively. Survival for patients with pT2 does not depend on the lymph node stage. Lymphovascular invasion is an independent parameter of impaired survival. 2
10. van Rhijn BW, Burger M, Lotan Y, et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol. 2009; 56(3):430-442. Review/Other-Tx N/A To review the current status of epidemiology, recurrence, and progression of NMIBC and the state-of-the art treatment for this disease. In NMIBC, approximately 70% of patients present as pTa, 20% as pT1, and 10% with CIS lesions. Bladder cancer is the fifth most frequent type of cancer in western society and the most expensive cancer per patient. Recurrence (in =80% of patients) is the main problem for pTa NMIBC patients, whereas progression (in =45% of patients) is the main threat in pT1 and CIS NMIBC. In a recent European Organisation for Research and Treatment of Cancer analysis, multiplicity, tumor size, and prior recurrence rate are the most important variables for recurrence. Tumor grade, stage, and CIS are the most important variables for progression. Treatment ranges from transurethral resection followed by a single chemotherapy instillation in low-risk NMIBC to, sometimes, re-transurethral resection and adjuvant intravesical therapy in intermediate- and high-risk patients to early cystectomy for treatment-refractory high-risk NMIBC. 4
11. Verma S, Rajesh A, Prasad SR, et al. Urinary bladder cancer: role of MR imaging. Radiographics. 2012; 32(2):371-387. Review/Other-Dx N/A To review the role of MRI in urinary bladder cancer. Substantial advances in MRI technology have made multiparametric MRI a feasible and reasonably accurate technique for the local staging of bladder cancer to optimize treatment. In addition, whole-body CT is the primary imaging technique for the detection of metastases in bladder cancer patients, especially those with disease that invades muscle. 4
12. Heney NM, Nocks BN, Daly JJ, et al. Ta and T1 bladder cancer: location, recurrence and progression. Br J Urol. 1982; 54(2):152-157. Review/Other-Tx 58 patients To analyze which tumor characteristics of, or associated with, superficial bladder cancer correlated with recurrent and/or progressive disease. Lamina propria invasion, multiple tumors, =3 cm, abnormal mucosal biopsy correlate with new tumors; progression associated with multiple tumors. 4
13. Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Palou J, Algaba F, Vicente-Rodriguez J. Primary superficial bladder cancer risk groups according to progression, mortality and recurrence. J Urol. 2000; 164(3 Pt 1):680-684. Observational-Tx 1,529 patients To identify risk groups in primary superficial bladder cancer according to progression, mortality and recurrence rates. Risk groups were classified as low — grade 1 stage Ta disease and a single grade 1 stage T1 tumor, intermediate — multiple grade 1 stage T1 tumors, grade 2 stage Ta disease and a single grade 2 stage T1 tumor, and high — multiple grade 2 stage T1 tumors, grade 3 stages Ta and T1 disease, and any stage disease associated with CIS. Survival analysis of progression, mortality and recurrence revealed a statistically significant difference among the 3 risk groups. The rates of recurrence, progression and mortality were 37%, 0% and 0% in the low, 45%, 1.8% and 0.73% in the intermediate, and 54%, 15% and 9.5% in the high risk group, respectively. The relative risks of recurrence, progression and mortality in the low vs the intermediate and high risk groups were 1.37, 2.84 and 1, and 1.87, 24.76 and 14.69, respectively. 3
14. Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Palou J, Vicente-Rodriguez J. Multivariate analysis of the prognostic factors of primary superficial bladder cancer. J Urol. 2000; 163(1):73-78. Review/Other-Tx 1,529 patients To evaluate the prognostic factors of recurrence, progression and disease specific mortality in patients with primary superficial Ta and T1 TCC of the bladder. Multiple tumors, tumor >3 cm and intravesical BCG instillations were risk factors of recurrence and progression. CIS influenced recurrence, progression and disease specific mortality. The main predictor of progression and mortality was grade 3 disease. 4
15. Herr HW. Tumor progression and survival of patients with high grade, noninvasive papillary (TaG3) bladder tumors: 15-year outcome. J Urol. 2000; 163(1):60-61; discussion 61-62. Observational-Tx 148 patients To evaluate tumor progression and survival of patients with high-grade Ta bladder tumors followed for 15 to 20 years. The 15-year progression-free survival rate was 95% in the 23 patients with low grade Ta tumors and none died of disease. Progression-free survival and disease specific survival rates were 61% and 74%, respectively, in 125 patients with high grade Ta tumors compared to 44% and 62%, respectively, in 73 with T1 tumors. 3
16. Lebret T, Bohin D, Kassardjian Z, et al. Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations. J Urol. 2000; 163(1):63-67. Observational-Tx 32 patients To evaluate recurrence and progression rates and the success of BCG therapy in patients with stage Ta grade 3 bladder cancer. Follow-up of 2 to 13 years (mean 58.4 months). The study demonstrates the high progression potential of stage Ta grade 3 tumors, since nearly 50% recurred and 25% progressed to invasive disease. 3
17. Heiken JP, Forman HP, Brown JJ. Neoplasms of the bladder, prostate, and testis. Radiol Clin North Am. 1994; 32(1):81-98. Review/Other-Dx N/A To review the current role of imaging in staging of cancers of the bladder, prostate and testis. CT is the imaging procedure of choice for postorchiectomy staging of testicular cancers. TRUS and MRI play important roles in the staging of prostate cancer. MRI, CT, and transurethral US are all capable of providing important information in the staging of bladder cancer. 4
18. Tobisu K, Tanaka Y, Mizutani T, Kakizoe T. Transitional cell carcinoma of the urethra in men following cystectomy for bladder cancer: multivariate analysis for risk factors. J Urol. 1991; 146(6):1551-1553; discussion 1553-1554. Review/Other-Tx 169 patients To examine, by multivariate analysis, the risk factors for occurrence of urethral TCC after cystectomy for bladder TCC. Significant risk factors were: papillary cancer, multiple cancers, and tumors in the bladder neck, prostatic urethra or prostate. 4
19. Denzinger S, Otto W, Fritsche HM, et al. Bladder sparing approach for initial T1G3 bladder cancer: Do multifocality, size of tumor or concomitant carcinoma in situ matter? A long-term analysis of 132 patients. Int J Urol. 2007; 14(11):995-999; discussion 999. Observational-Tx 132 patients To compare the long-term results in patients with initial T1G3 bladder cancer treated with transurethral resection of the bladder, BCG instillations and repeat resection with special regard to these clinical risk factors. The aim was to determine if they influence the outcome in the bladder sparing approach for initial T1G3 bladder cancer. 42% of patients had residual disease, 65% developed recurrence of any stage and 41% had progression to muscle invasive disease. Cancer-specific survival was 89% and 78% at 5 and 10 years, respectively. Only CIS was significantly correlated with all end points on multivariate analysis. While the presence of one or two risk factors was not related to recurrence, progression or cancer-related death, the presence of all three risk factors predicted the latter. 2
20. Kenworthy P, Tanguay S, Dinney CP. The risk of upper tract recurrence following cystectomy in patients with transitional cell carcinoma involving the distal ureter. J Urol. 1996; 155(2):501-503. Observational-Tx 430 patients To determine the risk of upper tract tumor recurrence in patients with cystectomy evidence of TCC involving the distal ureter. Upper tract tumors developed in 11 patients (2.6%) at a median of 40 months after radical cystectomy. Of the potential risk factors evaluated only the presence of TCC within the distal ureter showed a statistically significant correlation with upper tract recurrence (P=0.001). 6/11 recurrent neoplasms were asymptomatic. Among the patients with upper urinary tract recurrence 5 died of disease, 4 had no evidence of disease and 2 were alive with cancer. 2
21. Abdel-Latif M, Abol-Enein H, El-Baz M, Ghoneim MA. Nodal involvement in bladder cancer cases treated with radical cystectomy: incidence and prognosis. J Urol. 2004; 172(1):85-89. Observational-Tx 418 patients To study the factors that promote the incidence of nodal metastasis and characterize survival predictions in cases treated with radical cystectomy. Of the 418 cases nodal involvement was reported in 110 (26.3%). The mean number of harvested nodes per patient +/- SE was 17.9 +/- 6.7. The mean number of positive nodes per involved case was 4.1 +/- 5.4. A weak correlation between the number of retrieved nodes and number of positive nodes was noted (r = 0.4). Tumor pT stage and grade, and lymphovascular invasion were independent factors promoting the incidence of nodal involvement. 3-year disease-free survival in node positive cases was 37.8% +/- 4.8%. Two factors had an independent impact on survival in node positive cases, namely pT stage and the number of positive nodes. 2
22. Matzkin H, Soloway MS, Hardeman S. Transitional cell carcinoma of the prostate. J Urol. 1991; 146(5):1207-1212. Review/Other-Tx N/A Review article on histogenesis, pathology, staging, incidence, signs and symptoms, diagnosis, and treatment/prognosis for prostate TCC. Recommend transurethral biopsies of prostate gland in patients with high grade, multifocal bladder tumors, including CIS, to radiation therapy post TCC. 4
23. Soloway MS. Managing superficial bladder cancer: an overview. Urology. 1992; 40(6 Suppl):5-10. Review/Other-Tx N/A To provide an overview of the management of superficial bladder cancer. Treatment of low-grade, noninvasive bladder tumors should not be aggressive or produce morbidity; radical surgery for high grade tumors. 4
24. Kumar A, Kumar R, Gupta NP. Comparison of NMP22 BladderChek test and urine cytology for the detection of recurrent bladder cancer. Jpn J Clin Oncol. 2006; 36(3):172-175. Observational-Dx 131 patients To assess clinical performance of the NMP22 Bladder Check test in comparison to voided urine cytology for detection of recurrent bladder carcinoma. Sensitivity of Bladder Check Test was 85% in detection of recurrent bladder carcinoma compared with sensitivity of cytology (41%). Combining the tests provided an overall sensitivity of 91%. Conclusion was made that this test may substitute for voided urine cytology. 2
25. Messing EM, Teot L, Korman H, et al. Performance of urine test in patients monitored for recurrence of bladder cancer: a multicenter study in the United States. J Urol. 2005; 174(4 Pt 1):1238-1241. Observational-Dx 341 patients To assess the performance of the ImmunoCyt immunocytochemical test for detecting bladder cancer recurrence in patients with prior superficial bladder cancers compared with cystoscopic and histological findings. Overall sensitivity and specificity, respectively, was 23% and 93% for cytology, 81% and 75% for ImmunoCyt and 81% and 73% for the two combined tests. ImmunoCyt also detected 71% of <1 cm tumors. ImmunoCyt may have a role in decreasing frequency of cystoscopic examinations with low risk bladder cancer. 3
26. Varella-Garcia M, Akduman B, Sunpaweravong P, Di Maria MV, Crawford ED. The UroVysion fluorescence in situ hybridization assay is an effective tool for monitoring recurrence of bladder cancer. Urol Oncol. 2004; 22(1):16-19. Observational-Dx 19 patients To assess the UroVysion fluorescence in situ hybridization probe for detecting recurrent bladder cancer in voided urine. Results were compared with urine cytology and cystoscopy. Sensitivity and specificity, respectively was 87% and 100% for UroVysion and 43% and 100% for cytology. Supports additional research to determine whether UroVysion may serve to select patients for cystoscopy. 2
27. Bhuiyan J, Akhter J, O'Kane DJ. Performance characteristics of multiple urinary tumor markers and sample collection techniques in the detection of transitional cell carcinoma of the bladder. Clin Chim Acta. 2003; 331(1-2):69-77. Observational-Dx Group 1: 30 patients; Group 2: 233 patients Compare multiple tumor markers and diagnostic tools in detection of bladder cancer (telomerase, BTA stat, NMP22, Hb dip, chemiluminometric red cell assays). Sensitivity (77%) and specificity (98%) of telomerase activity in conjunction with chemiluminometric red cell or Hb dip assay may serve as an alternative to urine cytology. 4
28. van Rhijn BW, van der Poel HG, van der Kwast TH. Urine markers for bladder cancer surveillance: a systematic review. Eur Urol. 2005; 47(6):736-748. Review/Other-Dx 64 articles To systematically review the sensitivities and specificities of tumor markers for urothelial carcinoma as reported in the literature. Microsatellite analysis, ImmunoCyt, NMP22, CYFRA21-1, LewisX and FISH are the most promising markers for surveillance at this time. Nevertheless, clinical evidence is insufficient to warrant the substitution of the cystoscopic follow-up scheme by any of the currently available urine marker tests. 4
29. Soukup V, Babjuk M, Bellmunt J, et al. Follow-up after surgical treatment of bladder cancer: a critical analysis of the literature. Eur Urol. 2012; 62(2):290-302. Review/Other-Tx N/A To evaluate the existing evidence for intensity and duration of follow-up recommendations in patients after surgical treatment of bladder cancer. Follow-up in patients with NMIBC is necessary because of the high probability of tumor recurrence and the risk of progression. Cystoscopy plus cytology are the standard methods for follow-up. Cystoscopy should be done 3 months after the transurethral resection in every patient, and the frequency after that depends on the individual recurrence/progression risk. Cytology should be used as an adjunctive method to cystoscopy in intermediate- and high-risk patients. None of the currently available urinary markers or imaging methods can substitute for cystoscopy-based follow-up. High-risk NMIBC patients require regular lifelong upper urinary tract monitoring. Follow-up in muscle invasion bladder cancer is based on the fact that early detection of recurrence after radical cystectomy allows for timely treatment with the aim of improving outcomes. Patients with extravesical and lymph node-positive disease should have the most intensive follow-up because of the highest recurrence risk. Routine upper urinary tract imaging is advisable for all patients and should continue in the long term. Follow-up also allows for early detection of urinary diversion-related complications, the rate of which increases with time. 4
30. Agarwal PK, Black PC, Kamat AM. Considerations on the use of diagnostic markers in management of patients with bladder cancer. World J Urol. 2008; 26(1):39-44. Review/Other-Dx N/A To review the use of tumor markers for detecting bladder cancer recurrence. No results stated in abstract. 4
31. Messing EM, Catalona WJ. Urothelial tumors of the urinary tract. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. 7th ed. Philadelphia: W.B. Saunders Co.; 1998:2327-2408. Review/Other-Dx N/A Book chapter N/A 4
32. Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Bohle A, Palou-Redorta J. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol. 2008; 54(2):303-314. Review/Other-Dx N/A Systematic review was done to present updated guidelines for the diagnosis and treatment of NMIBC. Patients with tumors at low risk of recurrence and progression should have a cystoscopy at 3 months. If negative, the following cystoscopy is advised at 9 months and consequently yearly for 5 years (grade of recommendation: C). Patients with tumors at high risk of progression should have a cystoscopy and urinary cytology at 3 months. If negative, the following cystocopies and cytologies should be repeated every 3 months for a period of 2 years, every 4 months in the third year, every 6 months thereafter until 5 years, and yearly thereafter. A yearly exploration of the upper tract is recommended (grade of recommendation: C). Patients with intermediate risk of recurrence and/or progression should have an in-between follow-up scheme using cystoscopy and cytology, adapted according to individual factors (grade of recommendation: C). 4
33. Schmidbauer J, Lindenau G. Follow-up of nonmuscle invasive transitional cell carcinoma of the bladder: how and how often? Curr Opin Urol. 2008; 18(5):504-507. Review/Other-Dx N/A Review of recent literature regarding follow-up of NMIBC. Management of NMIBC has become more complex in respect to diagnosis, treatment and follow-up. Follow-up should therefore be based on individual patient-risk assessment. In addition to improved diagnosis by fluorescence-guided cystoscopy and other new diagnostic tools like optical-coherence tomography management has concentrated on optimizing different concepts of intravesical therapy. 4
34. Browne RF, Murphy SM, Grainger R, Hamilton S. CT cystography and virtual cystoscopy in the assessment of new and recurrent bladder neoplasms. Eur J Radiol. 2005;53(1):147-153. Observational-Dx 25 patients To assess the clinical usefulness of CT cystography and virtual cystoscopy in the assessment of new and recurrent bladder neoplasm. 17 masses larger than 0.5 cm were identified by CT cystography in 16 patients. Two patients had normal CT cystography, but one had small recurrent neoplasms on conventional examination. Seven patients had nodular mucosal irregularities which were subsequently shown to be neoplastic in three. Accuracy for diagnosis of neoplasm in all patients was 88%. CT cystography is very accurate at identifying masses larger than 0.5 cm and can show mucosal abnormalities as small as 2 mm. It is minimally invasive and can be diagnostic when conventional cystoscopy is inconclusive. It can indicate appropriate areas for assessment and biopsy at conventional examination. Virtual cystoscopy gave comparable views to conventional cystoscopy, but did not add diagnostic information. It is not likely to replace conventional cystoscopy, but may be helpful in occasional circumstances where the latter is inconclusive, or can not be performed. 4
35. Kishore TA, George GK, Bhat S. Virtual cystoscopy by intravesical instillation of dilute contrast medium: preliminary experience. J Urol. 2006; 175(3 Pt 1):870-874. Observational-Dx 11 patients with 14 tumors To examine the use of virtual cystoscopy using helical CT and intravesical instillation of dilute contrast medium. Images and findings were compared with conventional cystoscopy findings. An attenuation gradient of 350 HU between the vesical mucosa and urine was noted. 2/14 tumors (11 patients) were missed and each was 0.7 cm. All tumors >0.9 cm were detected. Overall sensitivity was 85.7%. There were no false-positive findings. There was good correlation with tumor location and size. The ureteral orifices and their relationship to the tumor were also well appreciated. Subtle mucosal changes on conventional cystoscopy were not delineated by virtual cystoscopy. 3
36. Tsampoulas C, Tsili AC, Giannakis D, Alamanos Y, Sofikitis N, Efremidis SC. 16-MDCT cystoscopy in the evaluation of neoplasms of the urinary bladder. AJR Am J Roentgenol. 2008;190(3):729-735. Observational-Dx 50 patients with 57 bladder lesions To evaluate the utility of 16-MDCT cystoscopy in the detection of urinary bladder neoplasms in a high-risk population. 55 (96%) of 57 urinary bladder lesions recognized at conventional cystoscopy were detected with MDCT cystoscopy. The size of the lesions ranged from 0.3 to 9.7 cm in diameter, including 18 lesions with a diameter of =0.5 cm. 2
37. Beer A, Saar B, Zantl N, et al. MR cystography for bladder tumor detection. Eur Radiol. 2004; 14(12):2311-2319. Observational-Dx 32 patients with 43 bladder tumors To assess the diagnostic performance of MR cystography with virtual cystoscopic and multiplanar reconstructions for detection of malignant bladder tumor. MR cystography is a noninvasive technique which demonstrates sensitivity of 92.3% for multiplanar reconstructions and 90.7% for virtual cystoscopic with a specificity of 91.1% for multiplanar reconstructions and 90.4% for virtual cystoscopic. Combined sensitivity was and specificity was 90.7% and 94.0%, respectively. 2
38. Schwartz CB, Bekirov H, Melman A. Urothelial tumors of upper tract following treatment of primary bladder transitional cell carcinoma. Urology. 1992; 40(6):509-511. Review/Other-Tx 638 patients To determine the incidence of upper tract TCC following treatment of primary bladder TCC in 638 patients. Subsequent upper tract tumors developed in 3.1% with a mean latency period, after treatment of 80 months. 4
39. Kundra V, Silverman PM. Imaging in oncology from the University of Texas M. D. Anderson Cancer Center. Imaging in the diagnosis, staging, and follow-up of cancer of the urinary bladder. AJR Am J Roentgenol. 2003; 180(4):1045-1054. Review/Other-Dx N/A To describe the epidemiology, histology, and imaging features of cancer of the urinary bladder. Included is a review of the staging system used for this malignancy. Diagnosis of early-stage disease is primarily by cystoscopy. After the tumor escapes the bladder wall, radiologic methods such as CT and MRI are critical for the evaluation of local invasion and distant metastasis. 4
40. Meissner C, Giannarini G, Schumacher MC, Thoeny H, Studer UE, Burkhard FC. The efficiency of excretory urography to detect upper urinary tract tumors after cystectomy for urothelial cancer. J Urol. 2007; 178(6):2287-2290. Review/Other-Dx 322 patients To determine the efficiency of routine excretory urography for detecting tumor recurrence in the upper urinary tract after cystectomy and urinary diversion for bladder cancer. The incidence of recurrence in the upper urinary tract after cystectomy for TCC was 4.7%. IVP detected only 8/15 upper tract recurrences. 4
41. Caoili EM, Cohan RH, Korobkin M, et al. Urinary tract abnormalities: initial experience with multi-detector row CT urography. Radiology. 2002; 222(2):353-360. Observational-Dx 65 patients To evaluate MDCT urography for detection of urinary tract abnormalities. MDCT urography depicted many clinically diagnosed urinary tract abnormalities, including 15/16 uroepithelial malignancies, 5 congenital anomalies, 5 urinary tract calculi, and 18 calyceal and/or papillary, 30 renal pelvic and/or ureteral, and 25 bladder abnormalities. All abnormalities were detected on transverse images. These abnormalities included diffuse urothelial wall thickening in 4 patients (3 of whom had TCC), a renal abscess, a colovesical fistula, and incidentally detected extrarenal disease (a liver mass, hepatic metastases, lymph node metastases, an aortic dissection, and a pheochromocytoma; each of these findings was seen in one patient). 3
42. Joffe SA, Servaes S, Okon S, Horowitz M. Multi-detector row CT urography in the evaluation of hematuria. Radiographics. 2003; 23(6):1441-1455; discussion 1455-1446. Review/Other-Dx N/A To show that hematuria can be well evaluated with a comprehensive contrast enhanced, MDCT. MDCT urography performed with a combination of unenhanced, nephrographic, and excretory phases can demonstrate a wide spectrum of disease in patients in a single study. 4
43. Jinzaki M, Matsumoto K, Kikuchi E, et al. Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract. AJR Am J Roentgenol. 2011; 196(5):1102-1109. Observational-Dx 104 patients and 552 urinary tract segments To compare the accuracy of CTU and excretory urography for the detection and localization of upper urinary tract urothelial carcinoma. Upper urinary tract urothelial carcinoma was diagnosed in 77 (14%) segments of 46 (44%) patients. Per-patient sensitivity, specificity, overall accuracy, and area under the receiver operating characteristic curves for detecting carcinomas with CTU (93.5% [43/46], 94.8% [55/58], 94.2% [98/104], and 0.963, respectively) were significantly greater than those for excretory urography (80.4% [37/46], 81.0% [47/58], 80.8% [84/104], and 0.831, respectively) (P=0.041, P=0.027, P=0.001, and P<0.001, respectively). Per-segment sensitivity and overall accuracy for the localization of upper urinary tract urothelial carcinoma were significantly greater with CTU (87.0% [67/77] and 97.8% [540/552]) than with excretory urography (41.6% [32/77] and 91.5% [505/552]) (P<0.0001). 3
44. Vikram R, Sandler CM, Ng CS. Imaging and staging of transitional cell carcinoma: part 2, upper urinary tract. AJR Am J Roentgenol. 2009; 192(6):1488-1493. Review/Other-Dx N/A To discuss the epidemiology, pathologic characteristics, and patterns of tumor spread. The authors also illustrate and discuss the role of imaging in the diagnosis, staging, and surveillance of TCC of the renal pelvis and the ureter. The hallmark of TCC is multiplicity and recurrence. Nearly 2%-4% of patients with bladder cancer develop upper tract TCC, but 40% of patients with upper tract TCC develop bladder cancer. Diagnosis of upper tract TCC is heavily dependent on imaging. Understanding the appearances of upper tract TCC on the different imaging techniques used is important in the accurate interpretation of imaging studies. Newer techniques such as CTU are now increasingly used instead of conventional excretory urography in the surveillance of the upper tract in patients with bladder cancer. 4
45. Cohan RH, Caoili EM, Cowan NC, Weizer AZ, Ellis JH. MDCT Urography: Exploring a new paradigm for imaging of bladder cancer. AJR Am J Roentgenol. 2009;192(6):1501-1508. Review/Other-Dx N/A To review the epidemiology, staging, and treatment of bladder cancer; to discuss the role of MDCT urography for the evaluation of patients with known or suspected bladder cancer; and to address the role of MDCT urography in patients who require follow-up imaging after a diagnosis of bladder cancer has been made. MDCT urography now has a large role in the evaluation of patients with known and suspected bladder cancer. However, its precise role has not been established. Because many bladder neoplasms will not be detected by MDCT urography and more research is needed to determine the optimal technique for diagnosing bladder cancer, the authors think that MDCT urography cannot replace cystoscopy at present. 4
46. Giannarini G, Kessler TM, Thoeny HC, Nguyen DP, Meissner C, Studer UE. Do patients benefit from routine follow-up to detect recurrences after radical cystectomy and ileal orthotopic bladder substitution? Eur Urol. 2010; 58(4):486-494. Observational-Dx 479 patients To determine whether diagnosis of asymptomatic recurrence after radical cystectomy by routine follow-up investigations confers a survival benefit versus symptomatic recurrence. 174/479 patients (36.3%) with tumor recurrence, 87 were diagnosed by routine follow-up investigations and 87 by symptoms. Routine follow-up mostly detected lung metastases and urethral recurrences, while symptoms were predominantly the result of bone metastases and concomitant pelvic/distant recurrences. Of 24 patients with urethral recurrences, 13 had CIS. Of these, 12 were successfully managed with urethra-sparing treatment, and 6 are still alive with no evidence of disease. Most other recurrent long-term survivors had lung and extrapelvic lymph node metastases. Cumulative 5-year survival rates of the entire cohort were 69.8% (95% confidence interval, 65.5%-74.3%) for CSS and 61.9% (95% confidence interval, 57.4%-66.7%) for OS. In multivariable analysis, mode of recurrence diagnosis and site of initial recurrence were the only independent predictors of CSS and OS. Patients with recurrences detected by routine follow-up investigations and with secondary urothelial tumors as site of recurrence had a slightly but significantly higher survival probability. 4
47. Thrasher JB, Crawford ED. Minimally invasive and metastatic transitional cell carcinoma (T1 and T2) In: Current Therapy in Genitourinary Surgery. 2nd edition. Resnick MI, Kursh E, eds.St. Louis, Mo: B.C. Decker. 1992:74-78. Review/Other-Tx N/A Book chapter: To review the treatment of minimally invasive bladder cancer, which at times may be aggressive. Treatment should be based on: the patient’s age, tumor “pathology and architecture”, and status of the remaining urothelium. 4
48. Fung CY, Shipley WU, Young RH, et al. Prognostic factors in invasive bladder carcinoma in a prospective trial of preoperative adjuvant chemotherapy and radiotherapy. J Clin Oncol. 1991; 9(9):1533-1542. Observational-Tx 40 patients To analyze clinical and pathologic factors in patients with localized muscle-invasive bladder tumors treated with bladder-preservation. Risk of bladder tumor recurrence was higher in patients with tumor-associated (CIS; 40%) than those without CIS (6%; P=.075). Papillary tumors and solid tumors both had similar treatment outcomes. By multivariate analysis, tumor stage T2 (P=.04) and absence of CIS (P=.03) were significant predictors of complete response; CIS was predictive of local bladder recurrence (P=.07); and tumor size (P=.03), response after chemoradiotherapy (P=.02), and vascular invasion (P=.08) were associated with distant metastasis. 6/8 local bladder tumor recurrences were superficial tumors. The low actuarial distant metastasis rate of T2 patients (0% at 3 years), the 3-year actuarial OS rates for T2 (89%) and T3-4 (50%) patients, and the similar treatment outcomes for papillary versus solid tumors are encouraging when compared with published historical controls. 1
49. Shinagare AB, Ramaiya NH, Jagannathan JP, Fennessy FM, Taplin ME, Van den Abbeele AD. Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor. AJR Am J Roentgenol. 2011;196(1):117-122. Review/Other-Tx 150 patients To evaluate the metastatic pattern of muscle-invasive bladder cancer and to correlate the findings with the characteristics of the primary tumor. The TCC group consisted of 94 (63%) patients and the atypical histologic features group of 56 (37%) patients. The most common metastatic sites were lymph nodes (104 patients, 69%), bone (71 patients, 47%), lung (55 patients, 37%), liver (39 patients, 26%), and peritoneum (24 patients, 16%). Patients with tumors of a more advanced T category had shorter metastasis-free intervals (P=0.001). There was no significant difference in the metastatic patterns of tumors in the different T categories. Patients with atypical histologic features had a shorter median metastasis-free interval (3 months; range, 0-29 months) than patients with TCC (12 months; range, 0-192 months) (P=0.0001). Patients with atypical histologic features had a significantly higher incidence of peritoneal metastasis (P<0.0002). 4
50. Zincke H, Garbeff PJ, Beahrs JR. Upper urinary tract transitional cell cancer after radical cystectomy for bladder cancer. J Urol. 1984; 131(1):50-52. Review/Other-Tx 425 patients To determine risk factors for the development of upper tract TCC after radical cystectomy for bladder TCC. There was a declining incidence of upper tract cancer relative to cystectomy P stage for CIS (9.1%), papillary stages O and A (3.6%), stages B1, C and D1 (2.6%) and no residual cancer (0%). Of the 14 patients, 8 (57%) had features of multifocal CIS in the cystectomy specimens. In 4/14 patients (29%) ipsilateral disease developed when the distal ureteral margins were involved with cancer at cystectomy. Only 3/14 patients (21.4%), all with stage I disease, were alive at the time of this report. 4
51. Gilbert SM, Veltri RW, Sawczuk A, et al. Evaluation of DD23 as a marker for detection of recurrent transitional cell carcinoma of the bladder in patients with a history of bladder cancer. Urology. 2003; 61(3):539-543. Observational-Dx 81 patients To determine whether DD23 monoclonal antibody increases the sensitivity of urinary based detection of TCC recurrence. DD23 had a sensitivity and specificity of 70.3% and 59.8% respectively. Combined with cytopathology, DD23 enhanced sensitivity from 20.0% to 55.0% for low grade TCC and from 64.0% to 76.0% for high grade TCC. In patients with a prior history of intravesical chemotherapy sensitivity was increased from 52.6% to 94.7%. DD23 may be used as an adjunct to urinary cytology for TCC detection and does not lose sensitivity in patients with history of intravesical therapy. 3
52. Oldbring J, Glifberg I, Mikulowski P, Hellsten S. Carcinoma of the renal pelvis and ureter following bladder carcinoma: frequency, risk factors and clinicopathological findings. J Urol. 1989; 141(6):1311-1313. Review/Other-Dx 657 patients To follow 657 primary bladder carcinomas to see the rate of occurrence of subsequent renal pelvis or ureteral cancers. In bladder carcinoma, no routine excretory urography unless recurrent or multiple tumors, previous cystectomy and/or ureteral orifice involvement. 4
53. Pfister C, Chautard D, Devonec M, et al. Immunocyt test improves the diagnostic accuracy of urinary cytology: results of a French multicenter study. J Urol. 2003; 169(3):921-924. Observational-Dx 694 patients To assess the clinical performance of ImmunoCyt (DiagnoCure, Inc., Saint-Foy, Canada) in the detection of bladder cancer in a 10-center French trial. A total of 85 recurrent and 58 newly diagnosed bladder tumors were diagnosed by cystoscopy and histologically confirmed. Overall sensitivity of urinary cytology was 17.9%, 46.3% and 63.8%, respectively, for G1, G2 and G3 TCC, whereas that of ImmunoCyt was 60.7%, 75.6% and 76.8%. Sensitivity of the combined tests was 66.7%, 78% and 87%, respectively. Moreover, 10/55 (18.2%) new pT1 and pT2 or greater tumors were diagnosed by ImmunoCyt alone. Specificity of urinary cytology was 94.5%, whereas that of ImmunoCyt was 84.2%. Specificity of the combined tests was 80.7%. Marked variations in urinary cytology sensitivity were observed among the different centers (27.3% to 66.7%), whereas combined assays (urinary cytology and ImmunoCyt) enhanced the overall sensitivity in the 80% range at most centers. 2
54. Vikram R, Sandler CM, Ng CS. Imaging and staging of transitional cell carcinoma: part 1, lower urinary tract. [Review] [37 refs]. AJR Am J Roentgenol. 192(6):1481-7, 2009 Jun. Review/Other-Dx N/A To discuss the epidemiology, pathologic characteristics, and patterns of tumor spread of bladder carcinomas. The authors illustrate and focus on the role of imaging in the diagnosis, staging, and surveillance of TCC. The hallmark of TCC is multiplicity and recurrence. Cystoscopy is the method of choice for evaluation of the primary tumor in patients with bladder carcinoma. Imaging acts as an adjunct to accurately stage disease in these patients. Nearly 2%-4% of patients with bladder cancer develop upper tract TCC. Hence, surveillance of the upper tract, in which imaging plays a central role, is an important component in the management of TCC. 4
55. Lamm DL, Griffith G, Pettit LL, Nseyo UO. Current perspectives on diagnosis and treatment of superficial bladder cancer. Urology. 1992; 39(4):301-308. Review/Other-Tx N/A To review current data and perspectives on the diagnosis and treatment of superficial bladder cancer. Additional intravesical immunotherapies are being developed with the hope of improving the treatment response. 4
56. Braslis KG, Soloway MS. Management of ureteral and renal pelvic recurrence after cystectomy. Urol Clin North Am. 1994; 21(4):653-659. Review/Other-Tx N/A To review the treatment options and follow-up of the upper tracts in patients post-cystectomy for bladder TCC. Nephroureterectomy is treatment of choice for upper tract TCC; low grade/stage can be treated with local therapy; TCC is bilateral 2%-4%. 4
57. Dondalski M, White EM, Ghahremani GG, Patel SK. Carcinoma arising in urinary bladder diverticula: imaging findings in six patients. AJR Am J Roentgenol. 1993; 161(4):817-820. Review/Other-Dx 6 patients To describe the radiologic findings in six patients with pathologically proved diverticular carcinomas. 3 of the tumors manifested as an intraluminal filling defect within a bladder diverticulum on excretory urograms or cystograms. In one patient, CT scans showed a concentric soft-tissue tumor in a diverticular neck. Correlative cystograms showed only smooth narrowing in this area. CT and MRI showed a tumor within a large diverticulum, which was not visualized on cystograms because of obstruction at the diverticular orifice. 4
58. American College of Radiology. ACR Appropriateness Criteria®: Pretreatment Staging of Invasive Bladder Cancer. Available at: Accessed 4 February 2013. Review/Other-Dx N/A ACR Appropriateness Criteria® evidence based guideline on pretreatment staging of invasive bladder cancer. N/A 4
59. Sudakoff GS, Guralnick M, Langenstroer P, et al. CT urography of urinary diversions with enhanced CT digital radiography: preliminary experience. AJR Am J Roentgenol. 2005; 184(1):131-138. Observational-Dx 24 patients To determine if 3D-renderd CTU depicts normal and abnormal findings in patients with urinary diversions and if addition of contrast-enhanced digital radiography improves collecting system opacification. 9 abnormalities were identified including distal ureteral strictures (n = 4), vascular compression of the mid left ureter (n = 1), scarring of the mid right pole infundibulum (n = 1), bilateral hydronephrosis and hydroureter (n = 1), urinary reservoir calculus (n = 1), and tumor recurrence invading the afferent limb of the neobladder (n = 1). 8/9 detected abnormalities were surgically or pathologically confirmed. All abnormalities were identified on all 3 imaging techniques but were best seen on 3-D CTU and enhanced CT digital radiography images. Incomplete opacification of the urinary collecting system occurred in 17 patients with CTU alone, 12 patients with contrast-enhanced CT digital radiography alone, and nine patients with combined CTU and contrast-enhanced CT digital radiography. Compared with CTU alone, the combined technique of 3D CTU and contrast-enhanced CT digital radiography improved opacification by a statistically significant difference (P=0.037). 3
60. Turney BW, Willatt JM, Nixon D, Crew JP, Cowan NC. Computed tomography urography for diagnosing bladder cancer. BJU Int. 98(2):345-8, 2006 Aug. Observational-Dx 200 patients To evaluate the use of CTU for diagnosing bladder tumors in patients with macroscopic hematuria and aged >40 years. The prevalence of bladder tumors was 24%; when CTU was compared with the histopathological findings, there was 1 false-positive and 3 false-negative diagnoses, indicating a sensitivity of 0.93 and a specificity of 0.99, with a 0.98 positive and 0.97 NPV for detecting bladder cancer. A review of the 3 false-negative cases showed that one was missed on original CTU reporting, the second had the appearance of prostate cancer on CTU and the third was a squamous metaplasia. 3
61. Sadow CA, Silverman SG, O'Leary MP, Signorovitch JE. Bladder cancer detection with CT urography in an Academic Medical Center. Radiology. 2008;249(1):195-202. Observational-Dx 838 CT urograms in 779 patients To evaluate the performance characteristics of CTU for the detection of bladder cancer in patients at risk for the disease. The overall sensitivity, specificity, accuracy, PPV, and NPV for bladder cancer detection were 79% (117/149), 94% (649/689), 91% (766/838), 75% (117/157), and 95% (649/681) for CTU and 95% (142/149), 92% (634/689), 93% (776/838), 72% (142/197), and 99% (634/641) for cystoscopy. The NPV of CTU was higher in patients evaluated for hematuria alone (98%, 589/603). However, the accuracy of CTU was considerably lower in patients with a prior urothelial malignancy (78%, 123/158). 3
62. Lawler LP. MR imaging of the bladder. Radiol Clin North Am. 2003; 41(1):161-177. Review/Other-Dx N/A MRI of the bladder is a practical and time-efficient exam for routine body imaging and particularly for tissue characterization of the bladder wall. MRI is complimentary to cystoscopy. However, there are limitations to its use in tumor detection and discrimination. 4
63. Mallampati GK, Siegelman ES. MR imaging of the bladder. Magn Reson Imaging Clin N Am. 2004; 12(3):545-555, vii. Review/Other-Dx N/A To review the benefits of MRI for characterizing and staging bladder masses and staging known bladder carcinoma. MRI can stage bladder cancers by determining the presence or absence of wall invasion as well as malignant adenopathy and metastases. 4
64. Johnson RJ, Carrington BM, Jenkins JP, Barnard RJ, Read G, Isherwood I. Accuracy in staging carcinoma of the bladder by magnetic resonance imaging. Clin Radiol. 1990; 41(4):258-263. Observational-Dx 34 patients To correlate staging of bladder cancer by MRI with pathology and clinical follow-up. MRI is accurate in defining tumors in or extending beyond the bladder wall; can discriminate advanced T3a lesions from T1, T2 and early T3a. 4
65. Tachibana M, Baba S, Deguchi N, et al. Efficacy of gadolinium-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging for differentiation between superficial and muscle-invasive tumor of the bladder: a comparative study with computerized tomography and transurethral ultrasonography. J Urol. 1991; 145(6):1169-1173. Observational-Dx 57 patients To compare gadolinium-enhanced MRI to CT and transurethral US for differentiation between superficial and muscle-invasive bladder tumors. A proper diagnosis was made in 42/57 cases (73.7%) by Gd-DTPA-enhanced MRI, in 27/57 (47.4%) by CT and in 31/57 (54.4%) by transurethral US when comparing the histological findings. The sensitivity and specificity for differentiating superficial and muscle-invasive tumor of each imaging method were, respectively, 96.2% and 83.3% in Gd-DTPA-enhanced MRI, 96.0% and 58.3% in CT, and 88.0% and 66.7% in transurethral US. 3
66. Tekes A, Kamel I, Imam K, et al. Dynamic MRI of bladder cancer: evaluation of staging accuracy. AJR Am J Roentgenol. 2005;184(1):121-127. Observational-Dx 71 patients To evaluate accuracy of gadolinium-enhanced MRI in staging bladder cancer in a series of patients with surgically proven bladder cancer. Staging accuracy: for all stages: 62%. Differentiating superficial from invasive tumors: 85%. Differentiating organ-confined from non-organ confined tumors: 82%. For lymph node involvement: 96%. Overstaging: 32%. Understaging: 6%. Time interval between MRI and transurethral US did not affect accuracy. 2
67. 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):869-875. Observational-Dx 27 patients To evaluate the correlation of radiological findings obtained by MRI study with pathological diagnosis in invasive bladder cancer treated with neoadjuvant chemotherapy, with or without radiation. Tumor stage assessed by MRI was consistent with pathological findings in 16/27 cases (59.3%), while MRI produced overstaging in 7 cases and understaging in 4 cases. The accuracy of staging was 75.0%, 30.0%, and 77.8% in groups A, B, and C, respectively. The accuracy of MRI staging in group B was lower than that in group C (P<0.05). There was no difference in the accuracy of MRI staging between groups A and C. 3
68. 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. Observational-Dx 36 patients To determine if DCE-MRI can predict failure of chemotherapy in patients with regionally metastatic or unresectable bladder cancer. After 2 cycles of chemotherapy, the accuracy, sensitivity, and specificity in distinguishing responders from nonresponders with conventional MRI were 69%, 81%, and 50%, respectively. With the fast DCE technique, accuracy, sensitivity, and specificity were 92%, 91%, and 93% respectively. The median bladder cancer specific survival was 28 months for all patients studied. Responders to chemotherapy at fast DCE-MRI had better median disease-specific survival than nonresponders (42 months vs 12 months [P<0.0001]). 3
69. Kilickesmez O, Cimilli T, Inci E, et al. Diffusion-weighted MRI of urinary bladder and prostate cancers. Diagn Interv Radiol. 2009; 15(2):104-110. Observational-Dx 23 patients with 14 urinary bladder carcinomas and 9 prostate carcinomas, and 50 healthy controls To evaluate the feasibility of DWI in the diagnosis of the urinary bladder and prostate carcinomas. The ADC values of the malignant and normal tissues were correlated. The mean ADC value of the urinary bladder wall of the control group and bladder carcinomas were (2.08 +/- 0.22 x 10(-3)mm(2)/s) and (0.94 +/- 0.18 x 10(-3)mm(2)/s), respectively. In addition, the ADC values of the normal peripheral (2.07 +/- 0.33 x 10(-3)mm(2)/s), transitional zones (1.46 +/- 0.23 x 10(-3)mm(2)/s) of the prostate, seminal vesicles (2.13 +/- 0.13 x 10(-3)mm(2)/s) and the prostate carcinomas (1.06 +/- 0.17 x 10(-3)mm(2)/s) were calculated. The comparison of mean ADC values of the peripheral-transitional zones of the prostate, normal bladder wall-bladder carcinomas, and peripheral zone prostate carcinomas were statistically significant (P<0.01). 3
70. Ceylan K, Taken K, Gecit I, et al. Comparison of cystoscopy with diffusion-weighted magnetic resonance images used in the diagnosis and follow-up of patients with bladder tumors. Asian Pac J Cancer Prev. 2010; 11(4):1001-1004. Observational-Dx 59 patients To compare DWI-MRI with cystoscopy in the diagnosis and follow-up of patients with bladder tumor and to investigate any histopathological correlation. While a mass in bladder was determined with cystoscopy in 43/59 patients, the mass was not determined in 16 of the patients (n=34 malignant, n=9 benign). While a mass was determined in 40/59 patients with DWI-MRI, the mass was not determined in 19 of the patients (n=40 malignant, n=19 benign). Regarding ADC values, mean ADC values of 34 patients who were diagnosed with a bladder tumor (1.05-/+0.22x10(-3) mm2/s), were significantly lower than the mean ADC values obtained from the normal bladder wall (1.830-/+0.18x10(-3) mm2/s). whereas a statistically significant difference was found (P<0.001). ADC values in 9 patients with a benign lesion (1.73-/+0.12x10(-3) mm2/s), were not found statistically different from the mean ADC values obtained from the normal bladder wall (1.78-/+0.2x10(-3) mm2/s) (P>0.05). A significant difference was determined between ADC values of benign lesions and the ADC values of malignant lesions (P<0.001). 3
71. El-Assmy A, Abou-El-Ghar ME, Mosbah A, et al. Bladder tumour staging: comparison of diffusion- and T2-weighted MR imaging. Eur Radiol. 2009; 19(7):1575-1581. Observational-Dx 106 patients To evaluate the clinical feasibility of DWI-MRI in detection and staging of urinary bladder tumor and to compare DWI-MRI with the T2-weighted technique. In DWI staging accuracy was 63.6% and 69.6% in differentiating superficial from invasive tumors and organ-confined from non-organ-confined tumors, respectively. On a stage by a stage basis, DWI accuracy was 63.6% (21/33), 75.7% (25/33), 93.7% (30/32) and 87.5% (7/8) for stages T1, T2, T3 and T4, respectively. In the T2-weighted technique, the overall staging accuracy was only 39.6% and accuracy for differentiating superficial from invasive tumors and organ-confined from non-organ-confined tumors was 6.1% and 15.1%, respectively. DWI is superior to T2-weighted MRI in staging of organ-confined tumors =T2) and both techniques are comparable in the evaluation of higher-stage tumors. 2
72. Takeuchi M, Sasaki S, Ito M, et al. Urinary bladder cancer: diffusion-weighted MR imaging--accuracy for diagnosing T stage and estimating histologic grade. Radiology. 2009; 251(1):112-121. Observational-Dx 40 patients with 52 bladder tumors To prospectively evaluate the ability of DWI-MRI to be used to determine the T stage of bladder cancer and to measure the correlation between the ADC and histologic grade. The overall accuracy of T stage diagnosis was 67% for T2-weighted images alone, 88% for T2-weighted plus DWI, 79% for T2-weighted plus contrast-enhanced images, and 92% for all 3 image types together. The overall accuracy, specificity, and A(z) for diagnosing T2 or higher stages were significantly improved by adding DWI (P<.01). The mean ADC of G3 tumors was significantly lower than that of G1 and G2 tumors (P<.01). 2
73. Yoshida S, Koga F, Kawakami S, 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):387-391. Observational-Dx 20 patients To investigate the feasibility of DWI-MRI in predicting therapeutic response to low-dose chemoradiotherapy against muscle-invasive bladder cancer. Pathologic examination of cystectomy specimens revealed pathologic complete response in 13 (65%) of the 20 patients. The sensitivity/specificity/accuracy of T2-weighted, DCE, and DWI in predicting pathologic response was 43%/45%/44%, 57%/18%/33%, and 57%/92%/80%, respectively. Despite comparable sensitivity, DWI was significantly superior in specificity and accuracy to T2-weighted (P=.03 and .02, respectively) and DCE (P=.002 for both). 3
74. Barentsz JO, Jager GJ, van Vierzen PB, et al. Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging. Radiology. 1996; 201(1):185-193. Observational-Dx 61 consecutive patients To evaluate contrast enhancement patterns of urinary bladder cancer and to evaluate fast dynamic first-pass MRI in tumor and node staging. Results with unenhanced T1- and T2-weighted images were compared with those obtained with the unenhanced images plus dynamic contrast material-enhanced single-section turbo FLASH images. Results with unenhanced T1- and T2-weighted images were compared with those obtained with the unenhanced images plus dynamic contrast material-enhanced single-section turbo FLASH images. Urinary bladder cancer started to enhance 6.5 seconds +/- 3.5 (standard deviation) after the beginning of arterial enhancement, which was 4 seconds earlier than most other structures (postbiopsy tissue, 13.6 seconds +/- 4.2). In differentiation of postbiopsy tissue from malignancy on the basis of the beginning of enhancement depicted on time and subtracted images, accuracy improved from 79% to 90% (P<.02) and specificity improved from 33% to 92% (not significant). Overall, tumor staging accuracy improved significantly from 67% to 84% (P<.01) by adding the turbo FLASH images. 2
75. Deserno WM, Harisinghani MG, Taupitz M, et al. Urinary bladder cancer: preoperative nodal staging with ferumoxtran-10-enhanced MR imaging. Radiology. 2004; 233(2):449-456. Observational-Dx 58 patients To prospectively evaluate ferumoxtran-10-enhanced MRI for nodal staging in patients with bladder cancer. Pre-contrast MRI evaluation of 172 nodes based on size and shape: Accuracy: 92%, sensitivity: 76%, specificity: 99%. Post-contrast MR evaluation of 172 nodes based on enhancement: Accuracy: 95%, sensitivity: 96%, specificity: 95%. Post-contrast imaging found 10/12 normal-sized pathologic nodes not detected on pre-contrast imaging. 2
76. Leyendecker JR, Barnes CE, Zagoria RJ. MR urography: techniques and clinical applications. Radiographics. 2008; 28(1):23-46; discussion 46-27. Review/Other-Dx N/A To review techniques and clinical applications of MRU. MRU is clinically useful in the evaluation of suspected urinary tract obstruction, hematuria, and congenital anomalies, as well as surgically altered anatomy, and can be particularly beneficial in pediatric or pregnant patients or when ionizing radiation is to be avoided. 4
77. Takahashi N, Glockner JF, Hartman RP, et al. Gadolinium enhanced magnetic resonance urography for upper urinary tract malignancy. J Urol. 2010; 183(4):1330-1365. Observational-Dx 91 MRU studies in 70 males and 18 females To retrospectively evaluate the accuracy of gadolinium enhanced MRU to detect upper urinary tract tumors. A total of 35 urinary tract regions in 18 males and 7 females with a mean age of 70.4 years were confirmed to have an upper tract malignant tumor and 219 urinary tract regions were confirmed to be tumor-free. Sensitivity, specificity and accuracy to detect upper urinary tract malignancy were 74.3%, 96.8% and 93.7% for reviewer 1, and 62.9%, 96.3% and 91.7% for reviewer 2, respectively. When patients with a ureteral stent or nephrostomy tube were excluded from analysis, sensitivity, specificity and accuracy were 86.2%, 99.5% and 97.7% for reviewer 1, and 72.4%, 97.9% and 94.6% for reviewer 2, respectively. 2
78. Lee KS, Zeikus E, DeWolf WC, Rofsky NM, Pedrosa I. MR urography versus retrograde pyelography/ureteroscopy for the exclusion of upper urinary tract malignancy. Clin Radiol. 2010; 65(3):185-192. Observational-Dx 35 patients To evaluate the diagnostic performance of MRU vs retrograde pyelography and/or ureteroscopy in the detection of upper urinary tract neoplasms. A total of 113 regions were analyzed on MRU and 90 regions on retrograde pyelography and/or ureteroscopy. 19 neoplasms were identified. Sensitivity, specificity, PPV, and NPV for the detection of urinary tract neoplasms were 63%, 91%, 60%, and 92% for MRU, respectively, and 53%, 97%, 83%, and 88% for retrograde pyelography and/or ureteroscopy, respectively. These differences were not statistically significant (P>0.05). 3
79. Stamatiou K, Moschouris H, Papadaki M, Perlepes G, Skolarikos A. Accuracy of modern ultrasonographic techniques in the follow up of patients with superficial bladder carcinoma. Med Ultrason. 2011; 13(2):114-119. Experimental-Dx 33 patients To establish the accuracy of modern US techniques in the follow-up of patients with superficial bladder carcinoma and to evaluate the patients tolerability of cystoscopy. 14/33 subjects were found to have bladder carcinoma recurrence on cystoscopy. In 11 cases (78.57%) US accurately diagnosed the bladder carcinoma. 2/3 patients in which, the US examination failed to clearly diagnose bladder carcinoma, were found with a tumor <3 mm while, in the remaining patient the tumor was located in the inner part of a diverticula. The sensitivity of modern US techniques in the diagnosis of bladder cancer recurrence was 78.5%, the specificity 100%, the PPV 100% and the NPV 86.3%. Regarding the patient tolerability for cystoscopy, 17 patients (51.5%) reported excessive discomfort-low tolerability, 9 (27.2%) moderate discomfort-intermediate tolerability and 7 (21.2%) reported no discomfort-high tolerability. 2
80. Ruether U, Guhl L, Schmidt A, et al. Intra- and perivesical tumor growth in preoperative staging of bladder cancer: the role of transrectal ultrasonography and high resolution magnetic resonance imaging. Urol Int. 1993; 50(3):141-147. Observational-Dx 46 patients To compare the sensitivity of TRUS with MRI for staging of bladder cancer. The sensitivity of both methods compared with pathohistology was 88%. TRUS and MRI are supplementary techniques leading to improved bladder tumor staging; TRUS is best for post-treatment monitoring. 4
81. Simon J, Bartsch G, Jr., Rinnab L, Hautmann RE, Volkmer BG. Transrectal ultrasound as diagnostic tool for the detection of local recurrence following cystectomy and urinary diversion. Urol Int. 2009; 82(1):12-16. Review/Other-Dx 642 male patients To determine the value of TRUS as diagnostic tool to diagnose local failure. Mean follow-up was 59.4 months. 83/642 patients (13%) had local failure of bladder cancer during follow-up. In 48/642 patients (7.5%) the local recurrence was the first site of recurrence. 35/642 patients (5.5%) developed local failure with concomitant distant disease. 31/83 patients met the inclusion criteria. The median time between cystectomy and diagnosis of local recurrence was 13 months (2-51 months). Routine follow-up detected local recurrence in 1 asymptomatic patient. 25/31, 3/31 and 2/31 patients had pain in the lower extremities/pelvis, hematuria and urinary retention, respectively. Digital rectal examination, transabdominal US, TRUS, and CT/MRI of the pelvis were suspicious for local recurrence in 9, 7, 26, and 29 patients, respectively. 4
82. 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. Observational-Dx 31 patients To assess the use of 3-D US and virtual sonographic cystoscopy for the detection of bladder tumors. 28 (90.3%) of 31 3-D virtual sonographic cystoscopic studies had good or excellent image quality. Conventional cystoscopy revealed 47 lesions in 22/28 patients; 3-D sonographic virtual cystoscopy showed 41 (87.2%) of 47 lesions. 3-D virtual sonography alone had sensitivity of 96.2%, specificity of 70.6%, a PPV of 93.9%, and a NPV of 80% for tumor detection. The combination of gray scale sonography, multiplanar reconstruction, and 3D virtual sonography had sensitivity of 96.4%, specificity of 88.8%, a PPV of 97.6%, and a NPV of 84.2% for tumor detection. 2
83. Bradford TJ, Montie JE, Hafez KS. The role of imaging in the surveillance of urologic malignancies. Urol Clin North Am. 2006; 33(3):377-396. Review/Other-Dx N/A To review the commonly used radiologic techniques for surveillance and offer recommended follow-up schedules for urologic malignancies. No results stated. 4
84. Slaton JW, Swanson DA, Grossman HB, Dinney CP. A stage specific approach to tumor surveillance after radical cystectomy for transitional cell carcinoma of the bladder. J Urol. 1999; 162(3 Pt 1):710-714. Observational-Tx 382 patients To describe the development of a stage specific protocol for monitoring patients with TCC for tumor recurrence and conduit complications after radical cystectomy. Of 97 patients with TCC metastases 72 (74%) were asymptomatic, including 43 with metastases detected by routine CXRs (30) or blood tests (13). Surveillance CT identified isolated asymptomatic intra-abdominal metastases in 10 patients (10%), of whom 90% had pT3 disease. Based on these results the authors recommend a stage specific surveillance protocol for pT1, annual history, physical examination, CXR and laboratory studies, pT2-same studies at 6, 12, 18, 24, 30, 36, 48 and 60 months after cystectomy, and pT3-same studies at 3, 6, 12, 18, 24, 30, 36, 48 and 60 months plus CT at 6, 12 and 24 months after cystectomy. A radiographic study of the upper tract should be performed in all patients every 1 to 2 years to evaluate for recurrences and complications of the ileoureteral anastomosis. 3
85. Shvarts O, Han KR, Seltzer M, Pantuck AJ, Belldegrun AS. Positron emission tomography in urologic oncology. [Review] [52 refs]. Cancer Control. 9(4):335-42, 2002 Jul-Aug. Review/Other-Dx N/A To determine the role of PET imaging in the evaluation of genitourinary malignancies. In testicular cancer, PET has a higher diagnostic accuracy than CT for both staging and re-staging and should be the test of choice for the assessment of a CT-visualized residual mass following chemotherapy. In prostate, renal, and bladder cancer, the current role of PET is still being defined, but it has a high PPV and can be used for problem solving in patients with indeterminate findings on conventional imaging. Its role in the diagnosis and staging of prostate cancer is hampered by the generally low glycolytic rate of most prostate tumors and their metastases. It has shown promise for staging and re-staging patients with advanced-stage disease and aggressive tumors suspected by a high tumor grade and high prostate-specific antigen velocity. PET has also demonstrated success when applied to renal cell carcinoma in classifying indeterminate renal masses as well as residual renal fossa masses following nephrectomy, gauging response to therapy, and staging and re-staging patients with a known diagnosis of renal cell carcinoma. 4
86. Bouchelouche K, Oehr P. Positron emission tomography and positron emission tomography/computerized tomography of urological malignancies: an update review. J Urol. 2008; 179(1):34-45. Review/Other-Dx N/A Review recent developments in PET and PET/CT for prostate, bladder and renal cancer. For prostate cancer FDG is not highly effective for primary diagnosis but it has a limited role in staging and recurrence detection. Promising results have been shown by 11C-choline, 18F-fluorocholine, 11C-acetate and 18F-fluoride. The role of 11C-methionine, 18F-fluoro-5-alpha-dihydrotestosterone and anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid remains to be elucidated. For bladder cancer FDG-PET is useful for identifying distant metastases but not for detecting primary tumors due to the urinary excretion of FDG. The role of 11C-choline and 11C-methionine remains to be evaluated further in clinical studies. For renal cancer FDG is of limited use for primary diagnosis but it has a role in staging and restaging of the disease. More clinical data are needed to investigate the roles of 18F-fluoromisonidazole and 18F-fluorothymidine. 4
87. Kosuda S, Kison PV, Greenough R, Grossman HB, Wahl RL. Preliminary assessment of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with bladder cancer. Eur J Nucl Med. 1997; 24(6):615-620. Observational-Dx 12 patients To evaluate the feasibility of FDG-PET in patients with bladder cancer. FDG-PET was true-positive in 8 patients (66.7%), but false-negative in 4 (33.3%). Of 20 organs with tumor mass lesions, 16 (80%) were detected by FDG-PET. FDG-PET detected all 17 distant metastatic lesions and 2 of 3 proven regional lymph node metastases. In 2 patients, FDG-PET differentiated viable recurrent bladder cancer from radiation-induced alterations. 4
88. Schoder H, Larson SM. Positron emission tomography for prostate, bladder, and renal cancer. Semin Nucl Med. 2004;34(4):274-292. Review/Other-Dx N/A Review article discussing use of PET in regards to prostate, bladder, and renal cancers. PET with 11C choline or acetate, but not with FDG, appears promising for the assessment of nodal metastases. Sensitivity for recurrent disease detection is higher with either acetate or choline as compared with FDG. Although more data need to be gathered, it is likely that these two agents will become the PET tracers of choice for staging prostate cancer. The few studies that investigated its role in the detection of lymph node metastases at the time of primary staging were largely disappointing. Bladder cancer imaging with 11C choline, 11C methionine, or 11C- acetate deserves further study. 4
89. Anjos DA, Etchebehere EC, Ramos CD, Santos AO, Albertotti C, Camargo EE. 18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. J Nucl Med. 2007;48(5):764-770. Observational-Dx 17 patients To investigate the role of PET/CT in the detection and restaging of bladder cancer using furosemide and oral hydration. PET/CT detected 6/11 tumors in patients who had not undergone cystectomy. 7/17 patients were upstaged only after review of delayed pelvic images. 3
90. Drieskens O, Oyen R, Van Poppel H, Vankan Y, Flamen P, Mortelmans L. FDG-PET for preoperative staging of bladder cancer. Eur J Nucl Med Mol Imaging. 2005; 32(12):1412-1417. Observational-Dx 55 patients To evaluate FDG-PET/CT in determining lymph node and distant metastatic involvement in invasive bladder cancer. As an extension, to determine prognostic yield of staging by PET. Overall sensitivity, specificity, and accuracy of PET/CT in diagnosis of metastatic or lymph node involvement was 60%, 88%, and 78%, respectively. Study limited by lack of a true fusion, PET/CT, lack of gold standard in all patients, CT images not available for review in all patients. 2
91. Kibel AS, Dehdashti F, Katz MD, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol. 2009; 27(26):4314-4320. Observational-Dx 43 chemotherapy-naive patients To report a prospective study of FDG-PET/CT in patients undergoing radical cystectomy for cT2-3N0M0 urothelial carcinoma of the bladder. Median follow-up was 14.9 months (range, 0.4 to 46.1 months). One patient who did not undergo lymphadenectomy was excluded from the pathology data analysis (n=42), whereas another patient who failed to return for follow-up was excluded from survival analysis (n=42). FDG-PET/CT demonstrated a PPV of 78% (7/9), a NPV of 91% (30/33), sensitivity of 70% (7/10), and specificity of 94% (30/ 32). Recurrence-free survival, disease-specific survival, and OS were all significantly poorer in the patients with positive FDG-PET/CT than in those with negative FDG-PET/CT. 2
92. Lodde M, Lacombe L, Friede J, Morin F, Saourine A, Fradet Y. Evaluation of fluorodeoxyglucose positron-emission tomography with computed tomography for staging of urothelial carcinoma. BJU Int. 2010;106(5):658-663. Observational-Dx 70 patients To investigate the role of FDG-PET combined with CT and forced diuresis, in the staging and follow-up of urothelial carcinoma. For the detection of primary urothelial bladder cancer, FDG-PET/CT was slightly more sensitive than CT (85% vs 77%) but less specific (25% vs 50%). For the detection of pelvic node metastasis FDG-PET/CT was more sensitive than CT (57% vs 33%) with a specificity of 100% for both imaging techniques. In 20 patients, extrapelvic FDG-PET/CT images showed suspected disease at the first evaluation. Urothelial carcinoma progressed in 9/10 patients who had synchronous multiple PET-positive retroperitoneal or mediastinal lymph nodes, and in only 2/9 with unique hyperactive lesions in the lung. FDG-PET/CT also detected a pT1G3 urothelial carcinoma of the renal pelvis and all bone metastases detected by bone scintigraphy. 2
93. Hillner BE, Siegel BA, Hanna L, et al. Impact of 18F-FDG PET used after initial treatment of cancer: comparison of the National Oncologic PET Registry 2006 and 2009 cohorts. J Nucl Med. 2012; 53(5):831-837. Review/Other-Dx Restaging or suspected recurrence (2006, n=30,911; 2009, n=54,747) chemotherapy monitoring (2006, n=10,234; 2009, n=15,611) To compare the impact of PET on intended management for the 7 most common cancer types that remained in NOPR after 2009 (bladder, kidney, pancreas, prostate, small cell lung, stomach, and uterus) and an aggregation of all other types for the periods before and after April 2009 (designated NOPR 2006 and NOPR 2009, respectively) when the use was categorized as subsequent treatment planning, including restaging or detection of suspected recurrence (henceforth collectively designated as restaging) or treatment monitoring. There were slight differences between time periods but little difference by cancer type or patient age within a time period. For restaging or suspected recurrence, comparing the 2006 and 2009 cohorts, total change in intended management for all cancer types was about 33% in those younger than age 65 and about 35% in those older than age 65 (range by cancer type, 31%–41%). The referring physician impression of disease extent (restaging) or prognosis (chemotherapy monitoring) after PET was similar between cohorts. In the 2009 cohort, PET for chemotherapy monitoring was associated with a 25% increase in plans to continue therapy and a complementary decline in plans to adjust therapy. The greatest management impact of PET was during chemotherapy monitoring in the 2009 cohort, where a post-PET prognosis judged to be worse than before PET was associated with a plan to discontinue that therapy in 90% and to change to a different therapy in 65%. 4
94. Picchio M, Treiber U, Beer AJ, et al. Value of 11C-choline PET and contrast-enhanced CT for staging of bladder cancer: correlation with histopathologic findings. J Nucl Med. 2006;47(6):938-944. Observational-Dx 27 patients To compare the diagnostic accuracy of contrast enhanced CT with 11C-choline PET for the staging of bladder cancer. The presence of residual bladder cancer (pTa-pT4) was correctly detected in 21/25 histologically tumor-positive patients (84%) by CT and in 24/25 patients (96%) by 11C-choline PET. Lymph node involvement was correctly detected in 4/8 patients (50%) by CT and in 5/8 patients (62%) by 11C-choline PET. The median size of the 3 nodes with false-negative PET results was 9 mm (range, 6-21 mm), and the median size of the metastatic lesions within the lymph nodes was 3 mm (range, 1-15 mm). CT resulted in 6 (22%) false-positive lymph nodes, whereas none was demonstrated by 11C-choline PET; these data indicated a significantly higher accuracy of PET than of CT (P<0.01). Both modalities missed a small peritoneal metastasis verified by histologic evaluation. No positive results were obtained from bone scintigraphy. 2