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1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7-30. Review/Other-Dx N/A To estimate the numbers of new cancer cases and deaths that will occur in the United States in the current year and compile the most recent data on cancer incidence, mortality, and survival. Mortality data were collected by the National Center for Health Statistics. In 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur in the United States. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher. However, sex disparities vary by cancer type. For example, thyroid cancer incidence rates are 3-fold higher in women than in men (21 vs 7 per 100,000 population), despite equivalent death rates (0.5 per 100,000 population), largely reflecting sex differences in the "epidemic of diagnosis." Over the past decade of available data, the overall cancer incidence rate (2004-2013) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2005-2014) declined by about 1.5% annually in both men and women. From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approximately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. 4
2. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017. Review/Other-Dx N/A To classify patients with cancer, define prognosis, and determine the best treatment approaches. No results stated in abstract. 4
3. Chang SS, Boorjian SA, Chou R, et al. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline. J Urol. 196(4):1021-9, 2016 Oct. Review/Other-Tx N/A To provide a clinical framework for the management of non-muscle invasive bladder cancer (NMIBC) A risk-stratified approach categorizes patients into broad groups of low-, intermediate-, and high-risk. Importantly, the evaluation and treatment algorithm takes into account tumor characteristics and uniquely considers a patient’s response to therapy. The 38 statements vary in level of evidence, but none include Grade A evidence, and many were Grade C. 4
4. Kim HS, Ku JH, Kim SJ, et al. Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study. Yonsei Med J. 57(4):855-64, 2016 Jul. Observational-Dx 2412 patients To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasivebladder cancer (NMIBC). With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence- free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. 3
5. Liu S, Hou J, Zhang H, et al. The evaluation of the risk factors for non-muscle invasive bladder cancer (NMIBC) recurrence after transurethral resection (TURBt) in Chinese population. PLoS ONE. 10(4):e0123617, 2015. Observational-Dx 698 patients To evaluate the potential risk factors of bladder cancer recurrence after transurethral resection of bladder based on a Chinese population. A total of 583 males (83.5%) and 115 females (16.5%) were enrolled in our study. The median follow-up duration was 51.5 months. Gender, chief complain, tumor size, number of lesions, histological grade and chemotherapeutic agents were found significantly associated with patients’ short-term recurrence (less than 1 year) (All p<0.05). In the multivariate analysis, tumor size, number of lesions, histological grade and chemotherapeutic agents were significantly related to patients’ short-term recurrence (less than 1 year) (All p<0.05). A multivariate model based on tumor size, number of lesions, histological grade and chemotherapeuticagents had an AUC of 0.697, which significantly improved the prediction utility for bladder cancer short-term recurrence (less than 1 year) than any single factor In the multivariate Cox regression, tumor size greater than 3 cm, multifocal lesions, worsen histological grade and non-urothelial carcinoma was related to time to recurrence (TR). 3
6. Zachos I, Tzortzis V, Mitrakas L, et al. Tumor size and T stage correlate independently with recurrence and progression in high-risk non-muscle-invasive bladder cancer patients treated with adjuvant BCG. Tumour Biol. 35(5):4185-9, 2014 May. Observational-Dx 144 patients To determine the prognostic significance of age, gender, associated carcinoma in situ, stage, number of tumors, and tumor size for patients with high-risk non-muscle-invasive bladder tumors treated with bacillus Calmette-Guerin (BCG). Patients were categorized into two groups: group A, complete responders without recurrence and without progression, and group B, patients with recurrence and with progression. Furthermore, group B was divided into two subgroups: group B1, patients with recurrence, and group B2, patients with progression. Univariate analysis of group B showed that only tumor size of >3 cm diameter (hazard ratio (HR) 11.99; 95% confidence interval (CI) range 5.69-25.3; p?<?0.001) is associated with recurrence. After multivariate analysis, the same factor appeared to be prognostic for recurrence as well. In addition, group B2 was statistically correlated with group B1. Univariate analysis proved that tumor stage (Ta or T1) is the unique factor associated with progression (HR 6.4; 95% CI 1.29-31.9; p?=?0.02). Tumor stage seems to be associated with disease's progression after the multivariate analysis too. 3
7. Lammers RJ, Hendriks JC, Rodriguez Faba OR, Witjes WP, Palou J, Witjes JA. Prediction model for recurrence probabilities after intravesical chemotherapy in patients with intermediate-risk non-muscle-invasive bladder cancer, including external validation. World J Urol. 34(2):173-80, 2016 Feb. Observational-Dx 724 patients To develop a model to predict recurrence for patients with intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) treated with intravesical chemotherapy which can be challenging because of the heterogeneous characteristics of these patients. A total of 724 patients were available for analyses, of which 305 were primary patients. Recurrences occurred in 413 patients (57 %). History of recurrences,history of intravesical treatment, grade 2, multiple tumors, and adjuvant treatment with epirubicin were relevant predictors for recurrence-free survival with hazard ratios of 1.48, 1.38, 1.22, 1.56, and 1.27, respectively. A table for recurrence probabilities was developed using these five predictors. Based on the probability of recurrence, three risk groups were identified. Patients in each of the separate risk groups should be scheduled for less or more aggressive treatment. The model showed sufficient discrimination and good predictive accuracy. External validation showed good validity. 3
8. Eifler JB, Barocas DA, Resnick MJ. Predictors of outcome in bladder cancer. J. Natl. Compr. Cancer Netw.. 12(11):1549-54, 2014 Nov. Review/Other-Dx N/A To address how current nomograms and risk tables may be best used to individualize bladder cancer management. No results stated in the abstract 4
9. Muppa P, Gupta S, Frank I, et al. Prognostic significance of lymphatic, vascular and perineural invasion for bladder cancer patients treated by radical cystectomy. Pathology. 49(3):259-266, 2017 Apr. Observational-Dx 1504 patients To examine a large cohort of surgically treated bladder cancer patients to determine the significance of lymphatic, vascular, and perineural invasion in predicting bladder cancer specific survival. Multivariate analysis showed that lymphatic and vascular invasion but not perineural invasion were significantly associated with cancer specific survival (p < 0.0001 and p = 0.02, respectively). There was a significant association of lymphatic and vascular invasion but not perineural invasion with involved regional    lymph nodes (p < 0.0001 and p = 0.004, respectively). In patients with metastasis to regional lymph nodes, lymphatic invasion remained significantly associated with outcome (p = 0.02). The frequency of lymphatic and vascular invasion varied amongst histological subtypes of bladder cancer. 2
10. 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
11. Kim SP, Frank I, Cheville JC, et al. The impact of squamous and glandular differentiation on survival after radical cystectomy for urothelial carcinoma. J Urol. 188(2):405-9, 2012 Aug. Observational-Tx 1013 patients To investigate the clinicopathological outcomes of patients treated with cystectomy for pure urothelial carcinoma vs urothelial carcinoma, and squamous and/or glandular differentiation. Patients with urothelial carcinoma, and squamous and/or glandular differentiation were more likely to have pT3-T4 tumors (70% vs 38%, p <0.0001)and pN+ disease (20% vs 15%, p = 0.05) than those with pure urothelial carcinoma. Median followup was 11.4 years. A total of 432 patients died ofbladder cancer, including 77 with histological differentiation and 355 with pure urothelial carcinoma. Ten-year cancer specific survival did not significantly differbetween patients with urothelial carcinoma and histological differentiation, and those with pure urothelial carcinoma (52% vs 51%, p = 0.71). After adjusting forclinicopathological features squamous and/or glandular differentiation was not significantly associated with the risk of death from bladder cancer (HR 0.79, p =0.10). 2
12. Linder BJ, Frank I, Cheville JC, et al. Outcomes following radical cystectomy for nested variant of urothelial carcinoma: a matched cohort analysis. J Urol. 189(5):1670-5, 2013 May. Observational-Tx 52 patients To evaluate oncological outcomes after radical cystectomy in patients with the nested variant of urothelial carcinoma and compare survival to that inpatients with pure urothelial carcinoma of the bladder. Patients with the nested variant had a median age of 69.5 years (IQR 62, 74) and a median postoperative followup of 10.8 years (IQR 9.3, 11.2). Nestedvariant cancer was associated with a high rate of adverse pathological features since 36 patients (69%) had pT3–T4 disease and 10 (19%) had nodal invasion.Eight patients (15%) with nested variant cancer received perioperative chemotherapy. When patients with the nested variant were matched to a cohort withpure urothelial carcinoma, no significant differences were noted in 10-year local recurrence-free survival (83% vs 80%, p = 0.46) or 10-year cancer specific survival (41% vs 46%, p = 0.75). 2
13. Wang JK, Boorjian SA, Cheville JC, et al. Outcomes following radical cystectomy for micropapillary bladder cancer versus pure urothelial carcinoma: a matched cohort analysis. World J Urol. 30(6):801-6, 2012 Dec. Review/Other-Dx 821 patients To report the outcomes of patients with MP bladder cancer treated with radical cystectomy (RC) and compare survival to patients with pure UC of the bladder. MP cancers were associated with a high rate of adverse pathologic features, as 48/73 patients (66 %) had pT3/4 tumors and 37 (50 %) had pN+ disease. Ten-year cancer-specific survival in MP patients was 31 %, compared with 53 % in the overall cohort with pure UC (p = 0.001). When patients with MP bladder cancer were then stage-matched to those with pure UC, no significant differences between the groups were noted with regard to 10-year local recurrence-free survival (62 vs. 69 %; p = 0.87), distant metastasis-free survival (44 vs. 56 %; p = 0.54), or cancer-specific survival (31 vs. 40 %; p = 0.41). 4
14. Herr HW, Milan TN, Dalbagni G. BCG-refractory vs. BCG-relapsing non-muscle-invasive bladder cancer: a prospective cohort outcomes study. UROL. ONCOL.. 33(3):108.e1-4, 2015 Mar. Observational-Tx 32 patients To test the hypothesis that BCG (bacille Calmette-Guérin)-refractory patients who fail to respond to BCG have worse outcomes after bladder-sparing treatments compared with BCG-relapsing patients whose tumors recur after at least a 6-month disease-free interval. Seventeen patients were classified as BCG refractory and 15 patients defined BCG relapsing. Recurrence-free median survivaltime was 10 months for BCG-refractory patients receiving mycobacterial cell wall–DNA complex vs. 23 months for BCG-relapsing patientswho received another induction course of BCG therapy (P = 0.002). Progression-free survival time was 18 months for BCG-refractory vs.52 months for BCG-relapsing patients (P = 0.001). Of the 17 BCG-refractory patients, 8 (47%) have died vs. 3 (20%) of the 15 BCGrelapsingpatients. 1
15. Shirakawa H, Kikuchi E, Tanaka N, et al. Prognostic significance of Bacillus Calmette-Guerin failure classification in non-muscle-invasive bladder cancer. BJU Int. 110(6 Pt B):E216-21, 2012 Sep. Review/Other-Tx 173 patients To investigate the differences in the clinical features and subsequent stage progression and disease-specific survival among patients with Bacillus Calmette-Guérin (BCG) failure, after dividing these patients into BCG-refractory, -resistant, -relapsing, and -intolerant groups. • Median follow-up period from initial BCG failure was 4.7 years. • A total of 42 patients (24.3%) were stratified into the BCG-refractory, three (1.7%) into the BCG-resistant, 106 (61.3%) into the BCG-relapsing, and 22 (12.7%)into the BCG-intolerant group.• Twenty-four patients (13.9%) experienced stage progression during follow-up.• Multivariate analysis showed that pathological G3 at BCG failure ( P = 0.014; risk ratio 2.84) and BCG-refractory ( P < 0.001; risk ratio 4.68) were independentpredictors for stage progression. The 10-year progression-free survival rates were 53.2%, 91.1% and 93.8% in the BCG-refractory, BCG-relapsing and BCG-intolerant groups, respectively. The stage progression rate was higher in the BCG-refractory than in the BCG-relapsing ( P < 0.001) and BCG-intolerant ( P = 0.007)groups.• Similarly, the 10-year disease-specific survival rate in the BCG-refractory group was significantly worse than those in the other BCG failure groups ( P < 0.001). 4
16. NCCN Clinical Practice Guidelines in Oncology. Bladder Cancer. Version 5.2018.  Available at: Review/Other-Tx N/A To provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with bladder cancer. No results stated in abstract. 4
17. Ok BG, Ji YS, Ko YH, Song PH. Usefulness of urine cytology as a routine work-up in the detection of recurrence in patients with prior non-muscle-invasive bladder cancer: practicality and cost-effectiveness. Korean J Urol. 55(10):650-5, 2014 Oct. Observational-Dx 393 patients To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness. Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence ratewas 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041). 3
18. Yafi FA, Brimo F, Auger M, Aprikian A, Tanguay S, Kassouf W. Is the performance of urinary cytology as high as reported historically? A contemporary analysis in the detection and surveillance of bladder cancer. UROL. ONCOL.. 32(1):27.e1-6, 2014 Jan. Observational-Dx 1,114 patients To evaluate sensitivity and specificity of urine cytology during a contemporary period at McGill University Health Center, Montreal, Quebec, Canada in comparison with historical analysis and other reported urinary biomarkers. On cytologic examination, 71% of specimens were benign, 23% atypical, and 6% suspicious or positive for urothelialcarcinoma. Reason for collection was surveillance in 61% and new symptoms in 28%. Depending on the tumor grade, sensitivity resultsranged from 10% for low-grade to 51% for high-grade tumors. Importantly, specificity of urine cytology ranged from 83% to 88%(depending on the type of urine collection and type of clinical presentation). Anticipatory positive rate was 44% after a median time of 15months. Specificity of other reported urinary markers ranges from 40% to 90%. 3
19. Chou R, Gore JL, Buckley D, et al. Urinary Biomarkers for Diagnosis of Bladder Cancer: A Systematic Review and Meta-analysis. [Review]. Ann Intern Med. 163(12):922-31, 2015 Dec 15. Meta-analysis 57 studies To systematically review the evidence on the accuracy of urinary biomarkers for diagnosis of bladder cancer in adults who have signs or symptoms of the disease or are undergoing surveillance for recurrent disease. Across biomarkers, sensitivities ranged from 0.57 to 0.82 and specificities ranged from 0.74 to 0.88. Positive likelihood ratios ranged from 2.52 to 5.53, and negative likelihood ratios ranged from 0.21 to 0.48 (moderate SOE for quantitative NMP22, qualitative BTA, FISH, and ImmunoCyt; low SOE for others). For some biomarkers, sensitivity was higher for initial diagnosis of bladder cancer than for diagnosis of recurrence. Sensitivity increased with higher tumor stage or grade. Studies that directly compared the accuracy of quantitative NMP22 and qualitative BTA found no differences in diagnostic accuracy (moderate SOE); head-to-head studies of other biomarkers were limited. Urinary biomarkers plus cytologic evaluation were more sensitive than biomarkers alone but missed about 10% of bladder cancer cases. Inadequate
20. 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
21. 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
22. Kobayashi H, Kikuchi E, Mikami S, et al. Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression. BMC Urol. 14:5, 2014 Jan 08. Review/Other-Dx 190 patients To evaluate the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system. Tumor recurrence and WP occurred in 82 (43.2%) and 21 (11.1%) patients during follow-up (median follow-up: 101.5 months), respectively. WP to high grade Ta, all T1 or Tis/concomitant CIS was seen in 17 patients, and UTR and progression to equal to or more than T2 were seen in 2 and 2 patients, respectively. Multivariate analyses demonstrated that multiple tumor (p < 0.001, HR: 2.97) and absence of intravesical instillation (IVI) (p < 0.001, HR: 2.88) were significant risk factors for tumor recurrence while multiple tumor was the only risk factor for WP (p = 0.001, HR: 5.26). After a 5-year tumor-free period, 9 patients experienced late recurrence in years 5 and 10 and were diagnosed at a follow-up cystoscopy, however, only 2 patients recurred beyond 10 years and werefound by gross hematuria. There were no significant risk factors of late recurrence. 4
23. Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Huguet-Perez J, Vicente-Rodriguez J. Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol. 164(4):1183-7, 2000 Oct. Observational-Dx 1529 patients 1. To evaluate the prognostic factors of primary superficial bladder cancer that may predict a metachronous upper urinary tract tumor.2. To determine whether the incidence of upper urinary tract disease varies according to risk group based on primary superficial bladdertumor classification. The incidence of upper urinary tract cancer was 2.6%. The only factor prognostic for an upper urinary tract tumor was multiplicity (relative risk 2.7, 95% confidence interval [CI] 1.06 to 6.84). All patients with an upper urinary tract tumor had a previously recurrent primary superficial bladder tumor. In the low, intermediate and high risk groups the incidence of upper urinary tract cancer was 0.6% (relative risk 1), 1.8% (relative risk 3.1, 95% CI 0.4 to 23.9) and4.1% (relative risk 8.3, 95% CI 1.1 to 61.6), respectively (chi-square and log rank tests p 5 0.007 and p ,0.05, respectively). 3
24. Hurle R, Losa A, Manzetti A, Lembo A. Upper urinary tract tumors developing after treatment of superficial bladder cancer: 7-year follow-up of 591 consecutive patients. Urology. 53(6):1144-8, 1999 Jun. Review/Other-Dx 591 patients To evaluate upper urinary tract tumor (UUTT) incidence and characteristics in 591 consecutive patients with low-, intermediate-, or high-risk superficial bladder cancer, who were followed up for at least 5 years or until death. After a median follow-up of 86 months (range 20 to 143), 2 (0.9%) of 216 patients at low risk, 4 (2.2%) of 182 patients at intermediate risk, and 19 (9.8%) of 193 patients at high risk developed UUTTs. The incidence of UUTTs is significantly higher in patients at high risk than in those at low risk (P 5 0.0004, oddsratio 5 11.6, 95% confidence interval [CI] 2.5 to 40.7) or at intermediate risk (P 5 0.004, odds ratio 5 4.8, 95% CI 1.5 to 17.2), or both (P 5 0.000006, odds ratio 5 7.3, 95% CI 2.6 to 20.3). The difference between patients at low risk and those at intermediate risk was not statistically significant (P 5 0.5, odds ratio 5 0.4,95% CI 0.02 to 2.6). After a median time of 36 months (range 9 to 119) from UUTT diagnosis, 5 (20%) of 25 patients have died of the disease. 4
25. 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
26. 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
27. Sternberg IA, Keren Paz GE, Chen LY, et al. Upper tract imaging surveillance is not effective in diagnosing upper tract recurrence in patients followed for nonmuscle invasive bladder cancer. J Urol. 190(4):1187-91, 2013 Oct. Observational-Dx 935 patients To evaluate the usefulness of routine upper tract imaging in patients followed for nonmuscle invasive bladder cancer. Of 935 patients treated and followed for nonmuscle invasive bladder cancer 51 were diagnosed with upper tract urothelial carcinoma. Median followupwas 5.5 years. The 5-year upper tract urothelial carcinoma-free probability among patients with Ta and T1 disease was 98% and 93%, respectively.The 10-year upper tract urothelial carcinoma-free probability among patients with Ta and T1 disease was 94% and 88%, respectively. Only 15 (29%) patientswere diagnosed on routine imaging while the others were diagnosed after symptoms developed. Overall 3,074 routine imaging scans were conducted for anoverall efficacy of 0.49% 3
28. Rosenkrantz AB, Ego-Osuala IO, Khalef V, Deng FM, Taneja SS, Huang WC. Investigation of Multisequence Magnetic Resonance Imaging for Detection of Recurrent Tumor After Transurethral Resection for Bladder Cancer. J Comput Assist Tomogr. 40(2):201-5, 2016 Mar-Apr. Observational-Dx 36 patients To evaluate multisequence magnetic resonance imaging (MRI) in detecting local recurrence after transurethral resection for bladder cancer. Forty-seven percent of patients had recurrent tumor at cystoscopy and biopsy. Using multisequence MRI, sensitivity and specificity were 67% and 81% for R1 and 73% and 62% for R2. Both readers missed 1 high-grade pathologic stage T1 recurrent tumor; otherwise, all missed tumors were low-grade pathologic stage Ta lesions. All false positives for R1 and 7 of 9 false positives for R2were in patients receiving previous bacillus Calmette-Guerin therapy. Furthermore, 40% to 50% of solitary abnormalities and 83%to 100%ofmultifocal abnormalitieswere tumor recurrences; 12% to 20% of smooth wall thickening, 50% to 75% of irregular wallthickening, and 88% to 100% of papillary masses were tumor recurrences. 2
29. Wang HJ, Pui MH, Guo Y, Yang D, Pan BT, Zhou XH. Diffusion-weighted MRI in bladder carcinoma: the differentiation between tumor recurrence and benign changes after resection. Abdom Imaging. 39(1):135-41, 2014 Feb. Observational-Dx 11 patients To investigate the efficacy of diffusion-weighted MRI (DWI) in differentiating recurrent tumor from chronic inflammation and fibrosis after cystectomy ortransurethral resection of bladder cancer. The accuracies, sensitivities, specificities, and positive predict values of DWI (92.6%, 100%, 81.8%, and 88.9%) were higher than those of DCEMRI (59.3%, 81.3%, 27.3%, and 54.2%) for detecting recurrent tumors. Using receiver operating characteristic analysis, the accuracy of DWI was significantly higher than that of DCE MRI (P < 0.05). There was no significant difference between DWI diagnosis and histopathology (P > 0.05), whereas the difference between diagnosis of DCEMRI and histopathology was significant (P < 0.05). The normalized apparent diffusion coefficients of recurrent tumors (0.697 ± 0.219) were significantly (P < 0.05) lower than those of postoperative inflammation or fibrosis (1.019 ± 0.143). 2
30. 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
31. Chamie K, Ballon-Landa E, Daskivich TJ, et al. Treatment and survival in patients with recurrent high-risk non-muscle-invasive bladder cancer. UROL. ONCOL.. 33(1):20.e9-17, 2015 Jan. Observational-Dx 4521 subjects To determine whether the increasing number of recurrences in patients with high-risk non–muscle-invasive bladder cancer is associated with higher subsequenttreatment and mortality rates. Of 4,521 subjects, 2,694 (59.6%) had multiple recurrences within 2 years of diagnosis. Compared with patients who only had 1recurrence, those with Z4 recurrences were less likely to undergo radical cystectomy (hazard ratio [HR] ¼ 0.73, 95% CI: 0.58–0.92), yetmore likely to undergo radiotherapy (HR ¼ 1.51, 95% CI: 1.23–1.85) and systemic chemotherapy (HR ¼ 1.58, 95% CI: 1.15–2.18). Forpatients with Z4 recurrences, only 25% were treated with curative intent. The 10-year cancer-specific mortality rates were 6.9%, 9.7%,13.7%, and 15.7% for those with 1, 2, 3, and Z4 recurrences, respectively. 3
32. Canter DJ, Revenig LM, Smith ZL, et al. Re-examination of the natural history of high-grade T1 bladder cancer using a large contemporary cohort. Int Braz J Urol. 40(2):172-8, 2014 Mar-Apr. Review/Other-Dx 222 patients To re-examine the natural history of HGT1 bladder cancer by analyzing the recurrence and progression rates of a large cohort of patients initially diagnosed with HGT1 disease to determine if, in fact, the high incidence of disease progression and death due to bladder cancer is still witnessed in a more contemporarytreatment era. A total of 222 patients were identified; 198 (89.1%) and 199 (89.6%) of whom were male and non-African American, respectively. Mean patient age was 66.5 years. 191 (86.0%) of the patients presented with isolated HG T1 disease while 31 (14.0%) patients presented with HGT1 disease and CIS. Induction BCG was utilized in 175 (78.8%) patients. Recurrence occurred in 112 (50.5%) patients with progression occurring in only 19 (8.6%) patients. At a mean follow-up of 51 months, overall survival was 76.6%. Fifty two patients died, of whom only 13 (25%) patient deaths were bladder cancer related. 4
33. Liedberg F, Hagberg O, Holmang S, et al. Local recurrence and progression of non-muscle-invasive bladder cancer in Sweden: a population-based follow-up study. Scand J Urol. 49(4):290-5, 2015. Review/Other-Dx 4715 patients To investigate recurrence and progression of non-muscle-invasive bladder cancer (NMIBC) in a large population-based setting. Local bladder recurrence and progression occurred in 50 and 9% of the patients, respectively. The rate of local recurrence was 56% in thesouthern healthcare region compared to 37% in the northern region. A multivariate Cox proportional hazards model, adjusting for age, gender, tumour stage and grade, intravesical treatment, healthcare region and hospital volume, showed that recurrence was associated with TaG2 and T1 disease, no intravesical treatment and treatment in the southern healthcare region, but indicated a lower risk of recurrence in the northern healthcare region. Adjusting for the samefactors in a multivariate analysis suggested that increased relative risk of progression correlated with older age, higher tumour stage and grade, and diagnosis in the Uppsala/Örebro healthcare region, whereas such risk was decreased by intravesical treatment (relative risk 0.72, 95% confidence interval 0.55–0.93, p = 0.012). 4
34. Miyake M, Gotoh D, Shimada K, et al. Exploration of risk factors predicting outcomes for primary T1 high-grade bladder cancer and validation of the Spanish Urological Club for Oncological Treatment scoring model: Long-term follow-up experience at a single institute. Int J Urol. 22(6):541-7, 2015 Jun. Observational-Dx 106 patients To determine the prognostic factors of primary T1 high-grade bladder cancer and to validate the Spanish Urological Club for Oncological Treatment model in Japanese patients with T1 high-grade bladder cancer treated at a single institution. Of 106 patients, 44 (42%) had recurrence and 16 (15%) developed progression after a median (interquartile range) follow-up period of 54 months (range 32–81 months). Non-papillary shape was the only independent predictor for recurrence, while broadbased tumor stalk and infiltrative tumor growth pattern at the invasion front were determined to be independent predictors for progression. Stratification of patients according to the number of progression risk factors yielded hazard ratios of 10.1 and 13.1 in patients having one and two risks, respectively, compared with those without any risks. The Spanish Urological Club for Oncological Treatment model successfully stratified our patients with a trend toward different probabilities of recurrence and progression. 3
35. Kim JY, Kim SH, Lee HJ, Kim MJ, Kim YH, Cho SH. MDCT urography for detecting recurrence after transurethral resection of bladder cancer: comparison of nephrographic phase with pyelographic phase. AJR Am J Roentgenol. 203(5):1021-7, 2014 Nov. Observational-Dx 121 patients To prospectively compare nephrographic phase MDCT urography performed with oral hydration and a diuretic with standard pyelographic phase MDCT in the detection of recurrence after transurethral resection. Urinary tract distention was rated significantly better at the pyelographic phase for all segments (p < 0.001). The degree of opacification provided by each radiologist for the same segment showed high correlation. There were 59 bladder recurrences in 38 patients and 19 upper tract recurrences in 13 patients. For recurrence detection in the bladder, the overall accuracy was significantly higher for the nephrographic phase than the pyelographic phase (91.7% [354/386] vs 83.2% [321/386], p = 0.038). For recurrence detection in the upper tract, the overall accuracy was significantly higher in the nephrographic phase thanin the pyelographic phase (86.7% [260/300] vs 80% [240/300], p = 0.028). 1
36. 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
37. 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
38. 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
39. 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
40. Hong X, Li T, Ling F, et al. Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis. Oncotarget. 8(10):17258-17269, 2017 Mar 07. Meta-analysis 36 articles, and 38,384 patients To assess the associations between the outcomes of bladder cancer, in terms of recurrence-free survival (RFS), cancerspecific survival (CSS) and overall survival (OS), and the presence of positive surgical margins versus negative surgical margins following treatment with radical cystectomy (RC) 4,354 patients were reported to have positive surgical margins. Significant associations were detected between positive surgical margins following RC and unfavorable RFS [summary relative risk estimate (SRRE), 1.63; 95% confidence interval (CI), 1.46-1.83; P = 0.105], CSS (SRRE, 1.82;95% CI, 1.63-2.04; P = 0.001) and OS (SRRE, 1.68; 95% CI, 1.58-1.80; P = 0.805), by fixed or random effects models. The findings were consistent independently of age, sample size, publication year, follow-up duration, study type and geographical region. Good
41. Mallen E, Gil P, Gil MJ. Risk groups in bladder cancer patients treated with radical cystectomy. Int Braz J Urol. 41(1):30-9, 2015 Jan-Feb. Observational-Dx 563 patients To stratify patients with bladder cancer into homogeneous risk groups according to statistically significant differences found in PFS (progression-free survival).To identify those patients at increased risk of progression and to provide oncological follow-up according to patient risk group. Median follow up time was 37.8 months. Recurrence occurred in a total of 219 patients (38, 9%). In 63% of cases this was distant recurrence.Only two variables retained independent prognostic value in the multivariate analysis for PFS: pathological organ confinement and lymph node involvement. By combining these two variables, we created a new “risk group” variable. In this second model it was found that the new variable behaved as an independent predictor associated with PFS. Four risk groups were identified: very low, low, intermediate and high risk:Very low risk: pT0 N0Low risk: pTa, pTis, pT2 and pN0Intermediate risk: pT3 and pN0High risk: pT4 N0 or pN1-3. 3
42. Nieuwenhuijzen JA, de Vries RR, van Tinteren H, et al. Follow-up after cystectomy: regularly scheduled, risk adjusted, or symptom guided? Patterns of recurrence, relapse presentation, and survival after cystectomy. Eur J Surg Oncol. 40(12):1677-85, 2014 Dec. Observational-Dx 343 patients To evaluate the efficacy of follow-up based on the patterns of recurrence, relapse presentation and survival after cystectomy, and to define a risk adjusted follow-up schedule. The risk of a recurrence was related to increasing pT, tumour positive lymph nodes, tumour positive surgical margins, and preoperative dilatation of the upper urinary tract, and low and high risk groups were defined consequently. 84% of all recurrences occurred within 2 years, with only one recurrence beyond 2 years in the low risk group. Although the minority of all patients (34%) is asymptomatic at time of recurrence, symptomatic recurrences were adversely associated with survival. CT-scans and chest X-rays accounted for 90% of the diagnostic tools to detect a recurrence in patients without symptoms. 3
43. Salama A, Abdelmaksoud AM, Shawki A, Abdelbary A, Aboulkassem H. Outcome of Muscle-Invasive Urothelial Bladder Cancer After Radical Cystectomy. Clin Genitourin Cancer. 14(1):e43-7, 2016 Feb. Review/Other-Tx 189 patients To clarify reasons for recurrence of urothelial carcinoma after radical cystectomy in a retrospective study that included 189 patients. The 3-year disease-free survival (DFS) rate was 56%. Seventy patients (37%) developed disease recurrence during the follow-up period. Of these recurrences, 17 patients (24.3%) developed local and/ or regional recurrences, 45 patients (64.3%) developed distant metastasis, and 8 patients (11.4%) developed localand/or regional and distant recurrences. In univariate analysis, lymph node metastasis (P < .001), lymphovascular invasion (LVI) (P < .001), high grade (P = .005), and advanced tumor stage (P = .002) were significantly associated with development of recurrence. In multivariate analysis, lymph node metastasis, LVI, and high grade were significantly associated with tumor recurrence and poor DFS. 4
44. Reddy AV, Pariser JJ, Pearce SM, et al. Patterns of Failure After Radical Cystectomy for pT3-4 Bladder Cancer: Implications for Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys. 94(5):1031-9, 2016 Apr 01. Observational-Dx 334 patients To describe patterns of LF, as well as assess factors associated with local-regional failure (LF) in a cohort of patients with pT3-4 bladder cancer. A total of 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperativechemotherapy. The median age was 71 years old, and median follow-up was 11 months. On univariate analysis, margin status, pT stage, and pN stage, were allassociated with LF (P<.05), however, on multivariate analysis, only pT and pN stages were significantly associated with LF (P<.05). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had a 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external and internal iliac lymph nodes (LNs) and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. 3
45. Moschini M, Karnes RJ, Sharma V, et al. Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: A 20-year single center experience. Eur J Surg Oncol. 42(5):735-43, 2016 May. Observational-Dx 1110 patients To describe recurrence patterns and characteristics related to survival in patients treated with radical cystectomy (RC) due to bladder cancer (BCa) Data from 1110 patients with urothelial non-metastatic BCa at RC were analyzed with 7.5 years of median follow up. Overall, 324 patients experienced recurrence and 200 (61.7%) were single site recurrence. The locations were: 43 local (22 cystectomy bed and 21 pelvic lymph node dissection template), 138 distant (36 lung, 19 liver, 52 bone, 17 extra pelvic LN, 7 peritoneal, 4 brain and 3 others) and 19 secondary urothelial carcinoma (11 upper urinary tract, 8 urethra). Significant independent predictors of overall recurrence were pathological stage pT3/T4 vs. pT0-2, pathological N positive status and positive surgical margin. Median overall survival after recurrence was 18 months. At multivariate analysis, pathological T3 (Hazard ratio [HR]: 1.62), T4 (HR: 1.58), interval from RC to recurrence (HR: 0.92) and distant (HR: 2.57) recurrences were independently associated with CSM (all p < 0.05). 3
46. Perlis N, Turker P, Bostrom PJ, et al. Upper urinary tract and urethral recurrences following radical cystectomy: review of risk factors and outcomes between centres with different follow-up protocols. World J Urol. 31(1):161-7, 2013 Feb. Experimental-Dx 574 patients To examine which patient-related and tumourrelated characteristics predict upper urinary tract recurrence (UUTR) and urethral recurrence (UR) of bladder cancer post-radical cystectomy (RC). Secondary objective is to evaluate whether or not recurrence patterns are similar between two centres with different post-RC follow-up (F/U) protocols. There was a 3.7 % risk of UUTR (21/574) and a 3.6 % risk of UR (18/503) for the combined cohort at a median F/U of 45 months. When controlling for the effectsof all variables modelled, female gender was a significant risk factor for UUT recurrence (OR 3.2, 95 % CI 1.0–9.5, p = 0.03) and prostatic urethral involvement was a significant risk factor for urethral recurrence (OR 7.8, 95 % CI 2.2–27.6, p = 0.001). UUTR were similar (p = 0.82) between Turku (8/205) and Toronto (12/369). Urethral recurrences trended (p = 0.06) towards being more common in Turku (9/151, 6.0 %) versus Toronto (9/352, 2.6 %), but no difference in overall survival was demonstrated between sites. 3
47. Mitra AP, Alemozaffar M, Harris BN, Schuckman AK, Skinner EC, Daneshmand S. Outcomes after urothelial recurrence in bladder cancer patients undergoing radical cystectomy. Urology. 84(6):1420-6, 2014 Dec. Observational-Dx 2029 patients To identify factors prognostic for survival after urothelial recurrence after radical cystectomy for bladder cancer. At median follow-up of 12 years, 25 (31.3%) and 55 (68.7%) patients experienced recurrence in the upper tract and urethra, respectively. Median time to recurrence, PRDSS, and PROS were 25.9, 58.4, and 48.7 months, respectively. Older age (P ¼ .018), patients with tumors that were upstaged at cystectomy compared with their clinical stage (P ¼ .049), and positive surgical margins (P ¼ .022) were associated with a lower PROS. The presence of symptoms at follow-up was associated with a poor PRDSS (P ¼ .028), which was confirmed by multivariable analysis. Patients experiencing urothelial recurrence within 2 years of cystectomy had a lower PRDSS (P ¼ .002) and PROS (P ¼ .003), which was confirmed by multivariable analysis. Site of urothelial recurrence did not influence time to recurrence (P ¼ .87), PRDSS (P ¼ .72), or PROS (P ¼ .57). 3
48. Balci U, Dogantekin E, Ozer K, Gorgel SN, Girgin C, Dincel C. Patterns, risks and outcomes of urethral recurrence after radical cystectomy for urothelial cancer; over 20 year single center experience. Int J Surg. 13:148-51, 2015 Jan. Review/Other-Dx 287 male patients To evaluate the factors affecting urethral recurrence after radical cystectomy for bladder cancer and relationship between urinary diversion type and urethral recurrence rates. A Total of 287 patients. Orthotopic continent urinary diversion (OCD) and ileal conduit (IC) was performed after radical cystectomy in 141 (49.1%) and 146 (50.9%) patients respectively. Urethral recurrence was observed in 11 (3.8%) patients and urethral recurrence rates in OCD and IC groups were 1.4% and 6.2% (p ¼ 0.034). Pathological stages of recurrent patients were 2 pT1, 1 pT2 and 8 pT4 respectively (p < 0.001). Urethral recurrence was significantly lower in OCD group when compared to IC group (p ¼ 0.036). When all parameters were analyzed using Cox multivariate regression analysis, the most important factor that affects urethral recurrence was pathological T stage (p < 0.001). Risk factors for urethral recurrence were present in 92 patients. Urethral recurrence rates in patients with and without risk factors were 8.69% and 1.53% (p < 0.01). 4
49. 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
50. 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
51. 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
52. 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
53. 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
54. 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
55. Alongi P, Caobelli F, Gentile R, et al. Recurrent bladder carcinoma: clinical and prognostic role of 18 F-FDG PET/CT. Eur J Nucl Med Mol Imaging. 44(2):224-233, 2017 Feb. Observational-Dx 41 patients To evaluate the accuracy, the effect upon treatment decision, and the prognostic value of 18F-fluorodeoxyglucose (FDG) PET/ Computedtomography (CT) in patients with suspected recurrent bladder carcinoma (BC) PET was considered positive in 21 of 41 patients. Of these, recurrent BC was confirmed in 20 (95 %). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG PET/CT were 87 %, 94 %, 95 %, 85 %, 90 %. AUC was 0.9 (95 %IC 0.8-1). Bayesian positive and negative likelihood ratios were 14.5 and 0.13, respectively. FDG PET/CT findings modified the therapeutic approach in 16 patients (modified therapy in 10 PET-positive patients,watch-and-wait in six PET-negative patients). PFS was significantly longer in patients with negative scan vs. those with pathological findings (85 % vs. 24 %, p < 0.05; HR= 12.4; p = 0.001). Moreover, an unremarkable study was associated with a longer OS (88 % vs. 47 % after 2 years and 87 % vs. 25 % after 3 years, respectively, p < 0.05). Standardized uptake value (SUV)max > 6 and total lesion glycolysis (TLG) > 8.5 were recognized as the most accurate thresholds to predict PFS (2-year PFS 62%for SUVmax < 6 vs. 15%for SUVmax > 6, p = 0.018; 2-year PFS 66 % for TLG < 8.5 vs. 18 % for TLG > 8.5, p = 0.09). 2
56. 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
57. 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
58. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4