| 1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023;73:17-48. |
Review/Other-Dx |
N/A |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. |
In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality. |
4 |
| 2. Zhang J, Gerst S, Lefkowitz RA, Bach A. Imaging of bladder cancer. Radiol Clin North Am. 2007;45(1):183-205. |
Review/Other-Dx |
N/A |
Review article on advances in imaging of bladder cancer. |
CT urography can be used as a one-stop-shop examination to evaluate the entire urinary system. The overall accuracy of 83% can be achieved by CT for local staging and 73%-92% for nodal evaluation. MRI has the potential to become the modality of choice in staging all pelvic malignancies. Dynamic contrast- enhanced MR yields higher accuracy than other imaging techniques. Differentiation of post-treatment changes in the bladder from tumor, however, still can be difficult. |
4 |
| 3. Amling CL. Diagnosis and management of superficial bladder cancer. Curr Probl Cancer. 2001;25(4):219-278. |
Review/Other-Dx |
N/A |
Review of diagnosis and staging of superficial bladder cancer; includes demographics and epidemiology. |
TCC accounts for greater than 90% of all bladder cancers; 70% of TCC present as superficial tumors; the remainder are invasive; 15%-20% of superficial tumors will progress to muscle invasion. |
4 |
| 4. Kirkali Z, Chan T, Manoharan M, et al. Bladder cancer: epidemiology, staging and grading, and diagnosis. Urology. 2005;66(6 Suppl 1):4-34. |
Review/Other-Dx |
N/A |
Review of bladder cancer epidemiology, staging and grading, and diagnosis. |
Controversies regarding the classification, grading, staging, and diagnosis of bladder cancer are discussed. Prospective studies needed to evaluate benefits of bladder cancer screening. |
4 |
| 5. 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 |
| 6. Wang D, Zhang WS, Xiong MH, Yu M, Xu JX. Bladder tumors: dynamic contrast-enhanced axial imaging, multiplanar reformation, three-dimensional reconstruction and virtual cystoscopy using helical CT. Chin Med J (Engl). 2004;117(1):62-66. |
Observational-Dx |
42 patients |
To evaluate clinical applications of helical CT dynamic contrast-enhanced axial imaging, MPR, 3D reconstruction and virtual cystoscopy in bladder tumors (benign and malignant). Results were compared with the findings of conventional cystoscopy and surgery in a double-blinded mode. |
Sensitivity in detecting bladder tumors: 90.8% axial. 76.9% 3D. 95.4% CT virtual cystoscopic. Axial CT 87.7% accurate in preoperative staging of bladder cancer, 76.9% for Ta-T2 and 94.7% for T3-T4. Axial able to detect pathologic lymph nodes in 6/7patients. MPR useful in demonstrating origin and extravesical invasion of tumors and relation to ureter. CT virtual cystoscopy could not provide extravesical information. The combination of axial, MPR, 3D and CT virtual cystoscopic images with helical CT can provide comprehensive information on bladder tumor. |
2 |
| 7. Mandalapu RS, Remzi M, de Reijke TM, et al. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma. [Review]. World Journal of Urology. 35(3):355-365, 2017 Mar. |
Review/Other-Dx |
N/A |
To provide an overview of the current indications and modalities of KPP in the management of low-risk UTUC, and assessing the recommendations based on the level of evidence and grade of recommendations. |
No results stated in abstract. |
4 |
| 8. Roupret M, Seisen T, Birtle AJ, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. [Review]. European Urology. 84(1):49-64, 2023 07.Eur Urol. 84(1):49-64, 2023 07. |
Review/Other-Tx |
N/A |
To aid clinicians in evidence-based management of UTUC. |
No results stated in abstract. |
4 |
| 9. Roth B, Wissmeyer MP, Zehnder P, et al. A new multimodality technique accurately maps the primary lymphatic landing sites of the bladder. Eur Urol. 2010;57(2):205-211. |
Observational-Dx |
60 consecutive cystectomy patients |
To use SPECT combined with CT plus intraoperative gamma probe verification to map the primary lymphatic landing sites of the bladder. |
A median of 4 (range: 1-14) radioactive lymph nodes were detected per site and patient. Ninety-two percent of all lymph nodes were found distal and caudal to where the ureter crosses the common iliac arteries. Eight percent were found proximal to the uretero-iliac crossing, none without simultaneous detection of additional radioactive lymph nodes within the endopelvic region. Extended pelvic lymph node dissection (PLND) resected 92% of all primary lymphatic landing sites; limited PLND resected only 52%. A few lymph nodes may have been missed despite preoperative SPECT/CT, intraoperative gamma probe verification, and extended backup PLND. Multimodality SPECT/CT plus intraoperative gamma probe show the template of the bladder's primary lymphatic landing sites to be larger than is often thought. PLND limited to the ventral portion of the external iliac vessels and obturator fossa removes only about 50% of all primary lymphatic landing sites, whereas extended PLND along the major pelvic vessels, including the internal iliac, external iliac, obturator, and common iliac region up to the uretero-iliac crossing, removes about 90%. |
3 |
| 10. 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 |
| 11. Saokar A, Islam T, Jantsch M, Saksena MA, Hahn PF, Harisinghani MG. Detection of lymph nodes in pelvic malignancies with Computed Tomography and Magnetic Resonance Imaging. Clin Imaging. 2010;34(5):361-366. |
Observational-Dx |
30 consecutive patients |
To compare conventional contrast-enhanced MRI to contrast-enhanced helical CT for their ability to detect pelvic lymph nodes in patients with known primary bladder or prostate malignancy. |
CT detected 189 nodes, and MRI detected 271 nodes. This difference was statistically significant in the external iliac (CT/MRI=73/87 nodes), obturator (CT/MRI=48/75 nodes), and internal iliac (CT/MRI=24/46 nodes) nodal chains. Based on size, the number of nodes detected by CT and MRI were as follows: 1–5 mm, CT/MRI=91/166; 6–10 mm, CT/MRI=91/98; N10 mm, CT/MRI=7/7 nodes. MRI detected significantly more lymph nodes in the size range of 1–5 mm. |
3 |
| 12. Thoeny HC, Froehlich JM, Triantafyllou M, et al. Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology 2014;273:125-35. |
Observational-Dx |
120 Patients |
To prospectively assess the diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) imaging in the detection of pelvic lymph node metastases in patients with prostate and/or bladder cancer staged as N0 with preoperative cross-sectional imaging. |
A total of 4846 lymph nodes were resected in 120 patients. Eighty-eight lymph node metastases were found in 33 of 120 patients (27.5%). Short-axis diameter of these metastases was less than or equal to 3 mm in 68, more than 3 mm to 5 mm in 13, more than 5 mm to 8 mm in five; and more than 8 mm in two. On a per-patient level, the three readers correctly detected metastases in 26 (79%; 95% CI: 64%, 91%), 21 (64%; 95% CI: 45%, 79%), and 25 (76%; 95% CI: 60%, 90%) of the 33 patients with metastases, with respective specificities of 85% (95% CI: 78%, 92%), 79% (95% CI: 70%, 88%), and 84% (95% CI: 76%, 92%). Analyzed according to hemipelvis, lymph node metastases were detected with histopathologic examination in 44 of 240 pelvic sides (18%); the three readers correctly detected these on DW MR images in 26 (59%; 95% CI: 45%, 73%), 19 (43%; 95% CI: 27%, 57%), and 28 (64%; 95% CI: 47%, 78%) of the 44 cases. |
2 |
| 13. 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 abstract available. |
4 |
| 14. 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 |
| 15. Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MK. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol 2011;29:2171-7. |
Experimental-Tx |
976 Patients |
To present the long-term results of the international multicenter randomized trial that investigated the use of neoadjuvant cisplatin, methotrexate, and vinblastine (CMV) chemotherapy in patients with muscle-invasive urothelial cancer of the bladder treated by cystectomy and/or radiotherapy. |
The previously reported possible survival advantage of CMV is now statistically significant at the 5% level. Results show a statistically significant 16% reduction in the risk of death (hazard ratio, 0.84; 95% CI, 0.72 to 0.99; P = .037, corresponding to an increase in 10-year survival from 30% to 36%) after CMV. |
1 |
| 16. Zaid HB, Patel SG, Stimson CJ, et al. Trends in the utilization of neoadjuvant chemotherapy in muscle-invasive bladder cancer: results from the National Cancer Database. Urology 2014;83:75-80. |
Observational-Dx |
5692 Patients |
To evaluate variation in neoadjuvant chemotherapy (NAC) use among patients with >/= clinical T2 (cT2) bladder cancer and determine changes in staging at radical cystectomy (RC) associated with therapy. |
A total of 5692 patients met our inclusion criteria, 962 (16.9%) of whom received NAC. A multivariable logistic regression model revealed several factors that negatively influenced receipt of NAC: increasing age, lower patient income, and treatment at a nonacademic institution (P <.01). Higher clinical stage and fewer comorbid conditions were associated with higher likelihood of receiving NAC (P <.01). The overall use of NAC increased from 7.6% in 2006 to 20.9% in 2010 (P <.01). Those receiving NAC were significantly more likely to be downstaged at RC (31.2% vs 7.6%, P <.01), with 10.6% achieving complete pathologic downstaging. |
3 |
| 17. Flaig TW, Spiess PE, Abern M, et al. NCCN Guidelines R Insights: Bladder Cancer, Version 2.2022. Journal of the National Comprehensive Cancer Network. 20(8):866-878, 2022 08. |
Review/Other-Tx |
N/A |
To provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with bladder cancer and other urinary tract cancers (upper tract tumors, urothelial carcinoma of the prostate, primary carcinoma of the urethra). |
No results stated in abstract. |
4 |
| 18. Funt SA, Rosenberg JE. Systemic, perioperative management of muscle-invasive bladder cancer and future horizons. Nat Rev Clin Oncol 2017;14:221-34. |
Review/Other-Dx |
N/A |
To review the evolution of chemotherapy and immunotherapy for muscle-invasive bladder cancer. |
No results in abstract. |
4 |
| 19. Coleman JA, Clark PE, Bixler BR, et al. Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline. Journal of Urology. 209(6):1071-1081, 2023 06. |
Review/Other-Tx |
N/A |
To to provide a useful reference on the effective evidence-based diagnoses and management of non-metastatic upper tract urothelial carcinoma (UTUC). |
No results stated in abstract. |
4 |
| 20. Peyronnet B, Seisen T, Dominguez-Escrig JL, et al. Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An European Association of Urology Guidelines Systematic Review. European Urology Focus. 5(2):205-223, 2019 03. |
Review/Other-Tx |
42 studies were included, which accounted for 7554 patients: 4925 in the open groups and 2629 in the laparoscopic groups. |
To systematically review all relevant literature comparing oncological outcomes of open versus laparoscopic RNU. |
No results stated in abstract. |
4 |
| 21. Beyersdorff D, Zhang J, Schoder H, Bochner B, Hricak H. Bladder cancer: can imaging change patient management? Curr Opin Urol. 2008;18(1):98-104. |
Review/Other-Dx |
N/A |
To discuss the impact of technical advances in CT, MRI, and PET on management of patients with bladder cancer. |
CT and MRI can visualize bladder cancer and perivesical infiltration, but MRI is superior for evaluation of the depth of invasion in the bladder wall. |
4 |
| 22. Babjuk M, Burger M, Comperat EM, et al. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ) - 2019 Update. [Review]. Eur Urol. 76(5):639-657, 2019 Nov. |
Review/Other-Tx |
N/A |
To provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation and recommendations. |
No results stated in abstract. |
4 |
| 23. Hartman R, Kawashima A. Lower tract neoplasm: Update of imaging evaluation. [Review]. European Journal of Radiology. 97:119-130, 2017 Dec. |
Review/Other-Dx |
N/A |
reviews the specific nature of lower tract cancers and their imaging. |
No results stated in abstract. |
4 |
| 24. Wolfman DJ, Marko J, Nikolaidis P, et al. ACR Appropriateness Criteria® Hematuria. J Am Coll Radiol 2020;17:S138-S47. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for hematuria. |
No results stated in abstract. |
4 |
| 25. Allen BC, Oto A, Akin O, et al. ACR Appropriateness Criteria® Post-Treatment Surveillance of Bladder Cancer. J Am Coll Radiol 2019;16:S417-S27. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for post-treatment surveillance of bladder cancer. |
No results stated in abstract. |
4 |
| 26. Shariat SF, Palapattu GS, Karakiewicz PI, et al. Discrepancy between clinical and pathologic stage: impact on prognosis after radical cystectomy. Eur Urol 2007;51:137-49; discussion 49-51. |
Observational-Dx |
778 Patients |
To compare clinical and pathologic staging in a large, contemporary, consecutive series of patients who were treated with radical cystectomy and pelvic lymphadenectomy, and determined the effect of stage discrepancy on outcomes. |
Pathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. Forty percent of patients with non-muscle-invasive clinical stage had muscle-invasive pathologic stage. Thirty-six percent of patients with organ-confined clinical stage had non-organ-confined pathologic stage (> or =pT3N0 or pTanyN-positive). Patients with higher clinical stage were more likely to be upstaged to non-organ-confined disease (p<0.001). Patients were stratified into three groups: pathologically upstaged, same clinical and pathologic stage, and pathologically downstaged. When adjusted for the effects of standard postoperative features, upstaged patients were at a significantly higher risk of disease recurrence and bladder cancer-specific death than patients who had the same pathologic and clinical stage, who in turn were at significantly higher risk than downstaged patients. This observation remained true within each clinical stage strata. Within each pathologic stage strata, clinical stage did not substratify into different risk groups. |
2 |
| 27. Paik ML, Scolieri MJ, Brown SL, Spirnak JP, Resnick MI. Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. J Urol. 2000;163(6):1693-1696. |
Observational-Dx |
82 consecutive cases |
To determine the accuracy of staging CT findings, usefulness before planned extirpative surgery and impact or surgical management of this disease. |
Overall accuracy in staging 54.9%. Understaging: 39%. Overstaging: 6.1%. Extravesical Spread: False positive: 4.9% False negative: 20.7% Lymph node involvement: False negative: 20.7% Preoperative CT altered planned surgical management 3.7%. Staging CT of the abdomen and pelvis in patients with invasive bladder carcinoma has limited accuracy, mainly because of its inability to detect microscopic or small volume extravesical tumor extension and lymph node metastases. CT tends to under stage advanced disease and failed to alter surgical management in nearly all of our cases. |
3 |
| 28. Tritschler S, Mosler C, Straub J, et al. Staging of muscle-invasive bladder cancer: can computerized tomography help us to decide on local treatment? World J of Urol 2012;30:827-31. |
Observational-Dx |
276 patients |
To assess the power of multi-detector row computerized tomography (MDCT) in daily routine as a basic staging procedure for the decision on local treatment of patients with bladder cancer. |
Accuracy of MDCT in predicting pathological tumour stage was 49% (kappa coefficient, 0.23; P < 0.001). Overstaging occurred in 23.4%, and understaging occurred in 24.7%. Accuracy in predicting lymph node metastases was 54% (kappa coefficient, 0.04; P = 0.297). Overstaging and understaging occurred in 8.3 and 29.4%, respectively. Significantly more ileal conduits were performed in patients with high postoperative pathological tumour stages (P = 0.04) and positive lymph nodes (P = 0.013). In contrast, there was no correlation between preoperative CT tumour/nodal stage and the number of removed lymph nodes (P = 0.44 and P = 0.732, respectively), and between preoperative tumour stage and type of urinary diversion (P = 0.126). |
3 |
| 29. Tritschler S, Mosler C, Tilki D, Buchner A, Stief C, Graser A. Interobserver variability limits exact preoperative staging by computed tomography in bladder cancer. Urology 2012;79:1317-21. |
Observational-Dx |
276 Patients |
To evaluate the agreement between radiologic staging of bladder cancer using multidetector row computed tomography (CT) and histopathologic staging and estimate the influence of interobserver variability of the CT findings as a potential limitation of this imaging modality. |
Preoperative CT scans were available for 276 patients who underwent radical cystectomy. The accuracy of the primary and reference radiologists in predicting the correct local tumor stage was 49% (kappa 0.23, P < .001) and 51% (kappa 0.24, P < .001), respectively. The accuracy in predicting the presence of lymph node metastases was 54% (kappa 0.04, P = .297) and 58% (kappa 0.15, P = .011). The agreement between both radiologists was fair with regard to the local tumor stage (kappa 0.23, P < .001) and the presence of lymph node metastases (kappa 0.35, P < .001). |
3 |
| 30. Rajesh A, Sokhi H, Fung R, Mulcahy KA, Bankart MJ. Role of whole-body staging computed tomographic scans for detecting distant metastases in patients with bladder cancer. J Comput Assist Tomogr. 2011;35(3):402-405. |
Observational-Dx |
201 patients |
To establish the incidence of distant metastases on whole-body CT scans in patients with newly diagnosed bladder cancer and to determine whether there is a significant difference in the incidence of metastases in patients with superficial and muscle invasive cancers. |
Of 201 patients, 11 (5.5%) were found to have distant metastases on CT. In univariable models, staging was not associated with either age (odds ratio, 0.98; 95% confidence interval, 0.92-1.04; P = 0.4) or sex (Fisher exact test, P = 0.07). Mean (SD) age was 74.1 (10.5) years. There was a significant association between staging and metastasis (odds ratio, 19.9; 95% confidence interval, 3.2-infinity; P = 0.0003). Of the patients, 7% of males had metastases versus 0% of the females. Staging CT scans for assessment of distant metastatic disease in patients with newly diagnosed bladder cancer can be restricted to patients with muscle invasive disease. |
3 |
| 31. European Association of Urology. EAU Guidelines Panel for Muscle-invasive and Metastatic Bladder Cancer (MIBC). Available at: https://uroweb.org/guidelines/muscle-invasive-and-metastatic-bladder-cancer. |
Review/Other-Tx |
N/A |
To help urologists assess the evidence-based management of MIBC and to incorporate guideline recommendations into their clinical practice. |
No results stated in abstract. |
4 |
| 32. Powles T, Bellmunt J, Comperat E, et al. Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022;33:244-58. |
Review/Other-Tx |
N/A |
To provide key recommendations for diagnosis, staging and management of bladder cancer. |
No results stated in abstract. |
4 |
| 33. Juri H, Koyama M, Azuma H, Narumi Y. Are there any metastases to the chest in non-muscle-invasive bladder cancer patients on follow-up computed tomography?. Int Urol Nephrol. 50(10):1771-1778, 2018 Oct. |
Observational-Dx |
328 patients |
To retrospectively determine whether there are metastases to the chest in patients with primary non-muscle-invasive urothelial carcinoma in the bladder on the follow-up computed tomography (CT). |
On univariate analysis, there were significant differences on T stage (p < 0.001) and histological grade (p = 0.001), and there was no significant difference on multifocal lesions (p = 0.11) and recurrence (p = 0.34). Positive findings of metastases were observed in 1.4% (1/74) of the Ta patients, 0% (0/78) of the T1 patients, 8.0% (2/25) of the patients with carcinoma in situ (CIS), and 27.2% (41/151) of the = T2 patients (p < 0.001). On multivariate analysis, T staging was independent variable for positive findings of metastasis (Odds ratio; 2.84, 95% Confidence Interval; 1.65-4.89). In contrast, histological grade, multifocal lesions, and recurrence were not independent variables. |
3 |
| 34. MacVicar AD. Bladder cancer staging. BJU Int. 2000;86 Suppl 1:111-122. |
Review/Other-Dx |
N/A |
Review bladder cancer staging. |
CT remains the mainstay of bladder cancer staging. CT cannot detect individual layers of the bladder wall and an important role of CT is to distinguish those tumors confined to the bladder wall from those spreading into the perivesical fat. CT has difficulty in tumor near the dome and trigone of the bladder and invasion with adjacent organs. MRI established an important imaging method for staging of bladder carcinoma and has the potential of becoming the investigation of choice. More accurate than CT in both local staging and lymph node metastases. MRI is the preferred technique for follow up imaging in patients post-cystectomy and radiation therapy. |
4 |
| 35. Mirmomen SM, Shinagare AB, Williams KE, Silverman SG, Malayeri AA. Preoperative imaging for locoregional staging of bladder cancer. [Review]. Abdom Radiol. 44(12):3843-3857, 2019 12. |
Review/Other-Dx |
N/A |
To review the recent literature and compare different imaging modalities for assessing the presence of muscle invasion and lymph node involvement prior to cystectomy and highlight the advantages of each modality. |
No results stated in abstract. |
4 |
| 36. Trinh TW, Glazer DI, Sadow CA, Sahni VA, Geller NL, Silverman SG. Bladder cancer diagnosis with CT urography: test characteristics and reasons for false-positive and false-negative results. Abdom Radiol. 43(3):663-671, 2018 03. |
Observational-Dx |
687 patients |
To determine test characteristics of CT urography for detecting bladder cancer in patients with hematuria and those undergoing surveillance, and to analyze reasons for false-positive and false-negative results. |
Ninety-five bladder cancers were detected. CT urography accuracy: was 91.5% (650/710), sensitivity 86.3% (82/95), specificity 92.4% (568/615), positive predictive value 63.6% (82/129), and negative predictive value was 97.8% (568/581). Of 43 false positives, the majority of interpretation errors were due to benign prostatic hyperplasia (n = 12), trabeculated bladder (n = 9), and treatment changes (n = 8). Other causes include blood clots, mistaken normal anatomy, infectious/inflammatory changes, or had no cystoscopic correlate. Of 13 false negatives, 11 were due to technique, one to a large urinary residual, one to artifact. There were no errors in perception. |
3 |
| 37. 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 |
| 38. Kawashima A, Vrtiska TJ, LeRoy AJ, Hartman RP, McCollough CH, King BF, Jr. CT urography. Radiographics. 2004;24 Suppl 1:S35-54; discussion S55-38. |
Review/Other-Dx |
N/A |
Review of the role of CT urography in the evaluation of patients with urologic disease. |
Neither excretory urography nor CT is as sensitive as cystoscopy. Gross urothelial tumor of the bladder can be detected. Ureteral obstruction caused by bladder cancer often a sign a muscle-invasive tumor. CT urography up to 97% sensitive in the detection of intrinsic urothelial lesions throughout the tract. |
4 |
| 39. 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 |
| 40. Chen L, Zhang G, Xu L, et al. Preoperative CT features to predict risk stratification of non-muscle invasive bladder cancer. Abdom Radiol. 48(2):659-668, 2023 02. |
Observational-Dx |
168 patients with pathologically confirmed NMIBC. |
To investigate whether preoperative CT features can be used to predict risk stratification of non-muscle invasive bladder cancer (NMIBC). |
The selected CT features were the maximum and the minimum diameter of the largest tumor, whether the largest tumor is located at the trigone, and tumor number. In the testing set, the model reached a macro- and micro- AUC of 0.783 and 0.745 with an accuracy of 0.529. As for the one-vs-rest problem, the model was most effective in identifying low-risk individuals, with an AUC, accuracy, sensitivity, and specificity of 0.870, 0.647, 1.000, and 0.438, respectively; the medium-risk group reached 0.814, 0.882, 0.250, and 0.936, respectively; the identification of the high-risk group was harder, going 0.665, 0.529, 0.250, and 0.870, respectively. |
3 |
| 41. Yajima S, Yoshida S, Takahara T, et al. Usefulness of the inchworm sign on DWI for predicting pT1 bladder cancer progression. Eur Radiol. 29(7):3881-3888, 2019 Jul. |
Observational-Dx |
91 patients |
To evaluate the significance of the presence or absence of an "inchworm sign" on DWI for the recurrence and progression of T1 bladder cancer. |
An inchworm sign was seen in 65 cases (71%), while it was absent in 26 cases. Among the 65, 25 (38%) had confirmed tumor recurrence, while in the remaining 26, 14 (54%) had confirmed recurrence (median time post TURB = 7.9 and 10.1 months for each). At the time of recurrence, the tumor had progressed in one (2%) inchworm-sign-positive and seven (27%) inchworm-sign-negative cases. The progression rate of inchworm-sign-negative cases was significantly higher than that of inchworm-sign-positive cases (hazard ratio = 17.2, p = 0.0017), whereas there was no significant difference in the recurrence rate between two groups. The absence of an inchworm sign and histological grade 3 were independent risk factors for progression (p < 0.001 and 0.010, respectively). |
2 |
| 42. Rosenkrantz AB, Friedman KP, Ponzo F, et al. Prospective Pilot Study to Evaluate the Incremental Value of PET Information in Patients With Bladder Cancer Undergoing 18F-FDG Simultaneous PET/MRI. Clin Nucl Med. 42(1):e8-e15, 2017 Jan. |
Observational-Dx |
22 patients |
To conduct a prospective pilot study comparing the diagnostic performance of MRI alone and F-FDG simultaneous PET/MRI using a diuresis protocol in bladder cancer patients. |
Of these patients, 82%, 38%, and 18% were positive for bladder, pelvic nodal, and nonnodal pelvic tumor, respectively. At a score of 3, PET/MRI exhibited greater accuracy for detection of bladder tumor (86% vs 77%), metastatic pelvic lymph nodes (95% vs 76%), and nonnodal pelvic malignancy (100% vs 91%). In the bladder, PET changed the level of suspicion in 36% of patients (50% increased suspicion, 50% decreased suspicion), with 75% of these changes deemed correct based on reference standard. For pelvic lymph nodes, PET changed suspicion in 52% (36% increase, 64% decrease), with 95% of changes deemed correct. For nonnodal pelvis, PET changed suspicion in 9% (100% increase), with 100% deemed correct. |
2 |
| 43. Eulitt PJ, Altun E, Sheikh A, et al. Pilot Study of [18F] Fluorodeoxyglucose Positron Emission Tomography (FDG-PET)/Magnetic Resonance Imaging (MRI) for Staging of Muscle-invasive Bladder Cancer (MIBC). Clin Genitourin Cancer. 18(5):378-386.e1, 2020 10. |
Observational-Dx |
21 patients |
To evaluate the use of preoperative FDG-PET/MRI for staging of MIBC. |
Eighteen patients were included in the final analysis, most (72.2%) of whom received neoadjuvant chemotherapy. Final pathology revealed 10 (56%) patients with muscle invasion and only 3 (17%) patients with lymph node involvement. Clustered analysis of FDG-PET/MRI radiology team reads revealed a sensitivity of 0.80 and a specificity of 0.56 for detection of the primary tumor with a sensitivity of 0 and a specificity of 1.00 for detection of lymph node involvement when compared with cystectomy pathology. CT imaging demonstrated similar rates in evaluation of the primary tumor (sensitivity, 0.91; specificity, 0.43) and lymph node involvement (sensitivity, 0; specificity, 0.93) when compared with pathology. |
3 |
| 44. Civelek AC, Niglio SA, Malayeri AA, et al. Clinical value of 18FDG PET/MRI in muscle-invasive, locally advanced, and metastatic bladder cancer. UROL. ONCOL.. 39(11):787.e17-787.e21, 2021 11. |
Observational-Dx |
15 patients (4 for surveillance; 11 for restaging) underwent 34 18F-FDG PET/MRI scans. |
To determine the clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) PET/MRI for surveillance and restaging of patients with muscle-invasive, locally advanced, and metastatic bladder cancer compared to conventional imaging methods. |
Fifteen patients (4 for surveillance; 11 for restaging) underwent 34 18F-FDG PET/MRI scans. Each patient received a corresponding conventional CT around the time of the 18F-FDG PET/MRI (median 6 days). The 15 patients (11 male; 4 female) had a median age of 61.5 years (range 37-73) and histologies of urothelial carcinoma (n = 13) and small-cell carcinoma of the bladder (n = 2) diagnosed as stage 4 (n = 13), stage 3 (n = 1), or stage 2 (n = 1). 18F-FDG PET/MRI detected 82 metastatic malignant lesions involving lymph nodes (n = 22), liver (n = 10), lung (n = 34), soft tissue (n = 12), adrenal glands (n = 1), prostate (n = 1), and bone (n = 2) with a resultant advantage of 36% for lesion visibility in comparison with CT. Serial imaging or biopsy confirmed these lesions as malignant. |
3 |
| 45. 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 |
| 46. Anderson TS, Regine WF, Kryscio R, Patchell RA. Neurologic complications of bladder carcinoma: a review of 359 cases. Cancer. 2003;97(9):2267-2272. |
Observational-Dx |
359 patients |
To review cases of patients with bladder carcinoma to determine nature and frequency of neurologic complications. |
52 patients had neurologic complications. 7 (2%) had lumbosacral plexopathies, 6 (2%) had metastatic epidural spinal cord compression. Non-metastatic complications were more common (metabolic encephalopathies in 24 patients (7%), peripheral neuropathies in 9 patients (2.5%), cerebral infarctions in 6 patients (2%), and seizures in 5 patients (1%). Study shows that neurologic complications are relatively uncommon. Local extension into peripheral nerves or bone, rather than hematogenous dissemination, is the most common cause of neurologic complications resulting from bladder carcinoma. |
4 |
| 47. 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 |
| 48. Wang HJ, Pui MH, Guo Y, et al. Multiparametric 3-T MRI for differentiating low-versus high-grade and category T1 versus T2 bladder urothelial carcinoma. AJR Am J Roentgenol 2015;204:330-4. |
Observational-Dx |
39 Patients |
To determine an optimal multiparametric MRI protocol for characterizing tumors of low versus high grade and differentiating tumors as T1 versus T2 for preoperative staging of bladder urothelial carcinoma. |
A total of 49 category T1 and T2 lesions were analyzed. The average ADC of 11 low-grade tumors (1.141 +/- 0.164 x 10(-3) mm(2)/s) was significantly (p < 0.05) higher than that of 20 high-grade malignant tumors (0.766 +/- 0.091 x 10(-3) mm(2)/s). Neither reader considered T1 tumors as probably having muscle invasion (category T2) in the T2-weighted plus DWI image sets or the T2-weighted plus DWI plus DCE-MRI image sets. Using the T2-weighted plus DCE-MRI sets, the two readers overstaged 13 and 15 of 36 tumors by misdiagnosing category T1 as T2. With the cutoff ADC value of 0.899 x 10-3 mm(2)/s, the sensitivity and specificity for differentiating high- and low-grade bladder urothelial carcinoma were 100% and 95%. |
1 |
| 49. Klein L, Pollack HM. Computed tomography and magnetic resonance imaging of the female lower urinary tract. [Review] [73 refs]. Radiol Clin North Am. 30(4):843-60, 1992 Jul. |
Review/Other-Dx |
N/A |
To review the use of CT and MRI of female lower urinary tract. |
Both CT and MR imaging are able to accurately stage bladder carcinoma, with MR imaging able to distinguish between superficial and deep muscle invasion of tumor. CT and MR are also the studies of choice for evaluating retroperitoneal fibrosis, which often affects the urinary tract; MR imaging is often able to detect the presence of active inflammation and occasionally rule out a malignant cause. MR imaging holds promise for the evaluation of stress urinary incontinence and urethral disease. Although diseases of the distal ureter continue to be most accurately diagnosed by intravenous urography and retrograde studies, CT and MR imaging may serve a helpful secondary role. |
4 |
| 50. 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 |
| 51. Ghafoori M, Shakiba M, Ghiasi A, Asvadi N, Hosseini K, Alavi M. Value of MRI in local staging of bladder cancer. Urol J 2013;10:866-72. |
Observational-Dx |
86 Patients |
To evaluate the accuracy of magnetic resonance imaging (MRI) in bladder cancer staging as well as differentiating superficial from invasive tumors and organ-confined from non-organ-confined tumors. |
The most common stage determined by both MRI and pathology was T2a. Considering stages in details, the kappa agreement coefficient between MRI and pathology was 0.8 (P < .0001). Combining groups a and b in each stage, the kappa agreement coefficient between MRI and pathology was 0.87 (P < .0001). Considering stages in details, we had 22 (20.3%) mismatches in staging between MRI and pathology; 10 (45.5%) were underestimation and 12 (54.5%) were overestimation. Combining groups a and b in each stage, we had 14 (13%) mismatch cases; 6 (46.2%) were underestimation and 8 (53.8%) were overestimation. The detection rate of MRI was 0% in stage Ta, 80% in stage T1, 88.1% in stage T2, 81.2% in stage T3, and 100% in stage T4. The sensitivity and specificity of MRI in differentiating superficial from deep tumors were 0.98 and 0.82, respectively. The sensitivity and specificity of MRI in differentiating organ-confined from non-organ-confined tumors were 0.93 and 0.94, respectively. |
2 |
| 52. Gupta N, Sureka B, Kumar MM, Malik A, Bhushan TB, Mohanty NK. Comparison of dynamic contrast-enhanced and diffusion weighted magnetic resonance image in staging and grading of carcinoma bladder with histopathological correlation. Urol Ann 2015;7:199-204. |
Observational-Dx |
60 Patients |
To evaluate and compare accuracy of Dynamic contrast enhanced (DCE) and Diffusion weighted (DW) MRI for preoperative T staging of urinary bladder cancer and find correlation between apparent diffusion coefficient (ADC) and maximum enhancement with histological grade. |
The extent of agreement between the radiologic staging and histopathological staging was relatively greater with the DW-MRI (kappa=0.669) than DCE-MRI (kappa=0.619). The sensitivity, specificity, and accuracy are maximum and similar for stage T4 tumors in both DCEMRI (100.0, 96.2 and 96.7) and DW-MRI (100.0, 96.2 and 96.7) while minimum for stage T2 tumors - DCEMRI (83.3, 72.2, and 76.7) and DWI-MRI (91.7, 72.2, and 80). |
3 |
| 53. Rabie E, Faeghi F, Izadpanahi MH, Dayani MA. Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Staging of Bladder Cancer. J Clin Diagn Res 2016;10:TC01-5. |
Observational-Dx |
45 Patients |
To evaluate the accuracy of dynamic gadolinium-enhanced MRI in staging of bladder cancer through differentiating superficial tumours from invasive tumours and organ-confined tumours from non-organ-confined tumours and investigate the benefits of DCE-MRI in diagnosis of tumor progression steps. |
The most common stage that was seen in pathology and MRI findings was T3b. Kappa agreement coefficient between MRI and pathology was 0.7 (p<0.001). The accuracy of MRI in differentiating superficial tumours (</=T1) from invasive tumours (>/= T2a), and organ-confined tumours (</=T2b) from non-organ-confined tumours (>/=T3b) was 0.97 and 0.84, respectively. The overall accuracy of MRI was 0.77 (p<0.001). Totally, 10 cases of disagreement between MRI and pathological staging were found, eight (80%) of which were overestimated and two cases (20%) underestimated. MRI detection rate was 0% in stage Ta, 100% in stage T1, 66.7% in stage T2, 86.7% in stage T3, and 100% in stage T4. The sensitivity and specificity of MRI in differentiating superficial tumours from invasive tumours were 0.97 and 1, respectively, and in differentiating organ-confined tumours from non-organ-confined tumours were 0.94 and 0.77, respectively. The Spearman's correlation coefficient between the signal enhancement slope of time-intensity curves and tumour stages was 0.88 (p<0.001). |
2 |
| 54. Rajesh A, Sokhi HK, Fung R, Mulcahy KA, Bankart MJ. Bladder cancer: evaluation of staging accuracy using dynamic MRI. Clin Radiol 2011;66:1140-5. |
Observational-Dx |
100 Patients |
To assess the accuracy of magnetic resonance imaging (MRI) in staging bladder cancer and to assess whether dynamic gadolinium-enhanced sequences have any added benefit in staging. |
On a stage-by-stage basis, tumours were correctly staged using MRI in 63% of patients (observed agreement=0.63, weighted kappa=0.57). The sensitivity and specificity of MRI to differentiate between superficial (</= T1) from invasive (>/= T2) disease was 78.2 and 93.3%. The observed agreement for this group was 85% (kappa=70%; p<0.0001). The sensitivity and specificity of MRI to differentiate between organ-confined (</= T2) from non-organ confined (>/= T3) disease was 90.5 and 60%. The observed agreement for this group was 89% (kappa=30%; p<0.01). Gadolinium-enhanced images improved staging in only three patients. |
2 |
| 55. Nguyen HT, Pohar KS, Jia G, et al. Improving bladder cancer imaging using 3-T functional dynamic contrast-enhanced magnetic resonance imaging. Invest Radiol. 49(6):390-5, 2014 Jun. |
Observational-Dx |
36 Patients |
To assess the capability of T2-weighted magnetic resonance imaging (T2W-MRI) and the additional diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) using multitransmit 3 T in the localization of bladder cancer. |
The sensitivity, specificity, and accuracy of the localization with T2W-MRI alone were 81% (29/36), 63% (5/8), and 77% (34/44) for observer 1 and 72% (26/36), 63% (5/8), and 70% (31/44) for observer 2. With additional DCE-MRI available, these values were 92% (33/36), 75% (6/8), and 89% (39/44) for observer 1 and 92% (33/36), 63% (5/8), and 86% (38/44) for observer 2. Dynamic contrast-enhanced MRI significantly (P<0.01) improved the sensitivity and accuracy for observer 2. For the 23 patients treated with chemotherapy, DCE-MRI also significantly (P<0.02) improved the sensitivity and accuracy of bladder cancer localization with T2W-MRI alone for observer 2. Scores of kappa were 0.63 for T2W-MRI alone and 0.78 for additional DCE-MRI. Of 7 subcentimeter malignant tumors, 4 (57%) were identified on T2W images and 6 (86%) were identified on DCE maps. Of 11 malignant tumors within the bladder wall thickening, 6 (55%) were found on T2W images and 10 (91%) were found on DCE maps. |
2 |
| 56. Panebianco V, Narumi Y, Altun E, et al. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System). [Review]. Eur Urol. 74(3):294-306, 2018 09. |
Review/Other-Dx |
N/A |
To define a standardized approach to imaging and reporting mpMRI for BC, by developing a VI-RADS score. |
No results stated in abstract. |
4 |
| 57. Wang H, Luo C, Zhang F, et al. Multiparametric MRI for Bladder Cancer: Validation of VI-RADS for the Detection of Detrusor Muscle Invasion. Radiology. 291(3):668-674, 2019 06. |
Observational-Dx |
340 patients |
To determine the performance of the VI-RADS score in detecting muscle-invasive bladder cancer in a cohort of patients undergoing multiparametric MRI before surgery. |
Of 340 tumors, 255 (75.0%) were verified as non–muscle-invasive and 85 (25.0%) as muscle-invasive bladder cancer. Both the VI-RADS score and its components were associated with muscle-invasive condition (P < .001). The area under the receiver operating characteristic curve for VI-RADS for muscle invasion was 0.94 (95% confidence interval [CI]: 0.90, 0.98). The sensitivity and specificity of a VI-RADS score of 3 or greater were 87.1% (95% CI: 78%, 93%) and 96.5% (95% CI: 93%, 98%), respectively. |
2 |
| 58. Kufukihara R, Kikuchi E, Shigeta K, et al. Diagnostic performance of the vesical imaging-reporting and data system for detecting muscle-invasive bladder cancer in real clinical settings: Comparison with diagnostic cystoscopy. Urologic Oncology. 40(2):61.e1-61.e8, 2022 02.UROL. ONCOL.. 40(2):61.e1-61.e8, 2022 02. |
Observational-Dx |
61 patients |
To compare the diagnostic performance of Vesical Imaging-Reporting and Data System (VI-RADS) scoring with diagnostic cystoscopy and evaluate diagnostic accuracies based on tumor locations. |
16 patients (26.2%) were pathologically diagnosed with MIBC. Regarding MI diagnostic accuracy, the sensitivity/specificity of VI-RADS scores were 93.8/88.9% by R1 and 87.5/86.7% by R2, while those of diagnostic cystoscopy were 56.3/68.9% by U1 and 68.8/84.4% by U2. Therefore, the diagnostic accuracy of VI-RADS was significantly higher than that of cystoscopy, particularly for tumors located on the bladder neck, trigone, dome, and posterior and anterior walls. Over- and under-diagnosis rates were higher with VI-RADS than with diagnostic cystoscopy (25.9% vs. 14.8%) for tumors located on the lateral wall or ureteral orifice. |
2 |
| 59. Makboul M, Farghaly S, Abdelkawi IF. Multiparametric MRI in differentiation between muscle invasive and non-muscle invasive urinary bladder cancer with vesical imaging reporting and data system (VI-RADS) application. Br J Radiol. 92(1104):20190401, 2019 Dec. |
Observational-Dx |
50 patients |
To evaluate role of multiparametric MRI (mp-MRI) in differentiation between invasive and non-invasive bladder cancer and accuracy of vesical imaging reporting and data system (VI-RADS) score. |
Diagnostic accuracy of mp-MRI in differentiation between muscle invasive and non-muscle invasive bladder cancer was (84%) with highest sensitivity (78%), very good agreement between mp-MRI and histopathological data (k = 0.87), and highest area under curve (AUC) reaching 0.83, dynamic contrast enhanced-MRI sequence showed the highest accuracy in muscle invasion detection by (88%), with highest AUC 0.83. Diagnostic accuracy of VI-RADS score in detection of muscle invasion was 84%, with specificity and negative predictive value of 88% and AUC was 0.83. Interobserver agreement was strong as regard diagnostic performance of mp-MRI and VI-RADS scoring for detection of muscle invasion reaching (K = 0.82, p < 0.001) and (K = 0.87, p < 0.001) respectively. |
3 |
| 60. Hagen F, Norz V, Thaiss WM, et al. Diagnostic benefit of multiparametric MRI over contrast-enhanced CT in patients with bladder cancer: A single-center 1-year experience. Eur J Radiol. 146:110059, 2022 Jan. |
Observational-Dx |
33 patients |
To assess the clinical applicability of local tumor staging in urinary bladder cancer (BC) with preoperative multiparametric MRI (mpMRI) using the five-point Vesical Imaging-Reporting and Data System (VI-RADS) scoring system and to compare it to dual-phase contrast-enhanced computed tomography (CECT). |
10 tumors were categorized as non-muscle invasive (30%) and 23 as muscle invasive BC (70%) in final histology. Tumor stages were correctly assigned as being either muscle invasive or non-muscle invasive on both CECT and mpMRI with regard to both early and late stages of BC (Ta-Tis and T3a-T4b). T-stages bordering the histopathologic limits of muscle invasiveness (T1-T2a-b) resulted in overestimation of muscle invasion in 43% of cases (VI-RADS 3-4) for the mpMRI image data sets and in an underestimation of muscle invasion in up to 55.5% of cases analysing the CECT data. Sensitivity and specificity for the determination of muscle invasion in CECT and mpMRI were 80%/80% and 74%/61% for Radiologist#1 and 70%/90% and 83%/70% for Radiologist#2, respectively. |
2 |
| 61. Daneshmand S, Ahmadi H, Huynh LN, Dobos N. Preoperative staging of invasive bladder cancer with dynamic gadolinium-enhanced magnetic resonance imaging: results from a prospective study. Urology. 2012;80(6):1313-1318. |
Observational-Dx |
122 Patients |
To evaluate the accuracy of dynamic gadolinium-enhanced magnetic resonance imaging (DGE-MRI) to detect extravesical bladder cancer (BC) and lymph node-positive disease in patients with invasive BC. |
A total of 122 patients (72 men) with a mean age of 67.8 years were included. Pathologic examination revealed invasive BC in 80/122 (65.5%), including stage pT4 in 15/122 (12.3%), pT3 in 27/122 (22.1%), and pT2 in 38/122 (31.1%), and 27 patients (22.1%) had node-positive disease. The interobserver agreement for T and N staging according to the kappa score was 0.44 and 0.49, respectively. The sensitivity, specificity, and accuracy of DGE-MRI in differentiating lymph node-negative organ-confined from nonorgan-confined BC was 87.5%, 47.6%, and 74% and for the detection of positive nodal disease was 40.7%, 91.5%, and 80.3%, respectively. |
2 |
| 62. Takahashi N, Kawashima A, Glockner JF, Hartman RP, Kim B, King BF. MR urography for suspected upper tract urothelial carcinoma. Eur Radiol. 19(4):912-23, 2009 Apr. |
Review/Other-Dx |
N/A |
To describe the utility of MRU for detecting upper tract urothelial carcinoma. |
No results stated in abstract. |
4 |
| 63. Takahashi N, Kawashima A, Glockner JF, et al. Small (<2-cm) upper-tract urothelial carcinoma: evaluation with gadolinium-enhanced three-dimensional spoiled gradient-recalled echo MR urography. Radiology. 2008;247(2):451-457. |
Observational-Dx |
110 patients; 11 patients with 23 upper-tract urothelial carcinomas < 2 cm |
To retrospectively evaluate the detection of small (<2-cm) urothelial tumors by using gadolinium-enhanced 3D spoiled gradient-recalled echo (GRE) MR urography. |
Of 23 tumors, 17 (74%) were detected by using at least one sequence, eight (35%) were detected with T2-weighted imaging, 15 (65%) were detected on nephrographic phase images, and 15 (65%) were detected on excretory phase images. Two lesions each were detected only on either nephrographic or excretory phase images. Detectability was significantly higher on nephrographic and excretory phase images compared with T2-weighted images (P < .05). Gadolinium-enhanced 3D spoiled GRE MR urography helped detect 74% of small urothelial carcinomas. Nephrographic and excretory phase images are essential for helping detect small urothelial carcinomas. |
4 |
| 64. Tadin T, Sotosek S, Rahelic D, Fuckar Z. Diagnostic accuracy of ultrasound T-staging of the urinary bladder cancer in comparison with histology in elderly patients. Coll Antropol 2014;38:1123-6. |
Observational-Dx |
156 Patients |
To evaluate diagnostic accuracy of ultrasound T-staging (UTS) of UBC in dhe group of elderly patients. |
In 152 elderly patients referred to transabdominal ultrasound examination in two different facilities (76 each) due to various symptoms (primarily painless gross or microscopic haematuria) UBC was diagnosed. Initial UTS at the moment of detection was performed and compared with final histological T-staging (HTS). A high level of conformity between UTS and HTS was detected. In a total of 152 patients with UBC there were 115 (75.66%) patients with complete match between the UTS and HTS, 24 (15.79%) patients with minimal variation within one stage, and 13 (8.55%) patients with one stage difference between the UTS and HTS. The best result was established for the stage T1, where the accuracy was 94.5%. In other stages the accuracy was between 84.9% and 91.8%. The Youden's index for all the stages was over 0.6. UTS has a high diagnostic accuracy, especially for stages T1 and T2. |
3 |
| 65. Datta SN, Allen GM, Evans R, Vaughton KC, Lucas MG. Urinary tract ultrasonography in the evaluation of haematuria--a report of over 1,000 cases. Ann R Coll Surg Engl. 84(3):203-5, 2002 May. |
Review/Other-Dx |
1007 patients. |
To present the data on over 1000 patients investigated for predominantly visible haematuria and evaluate the use of ultrasonography as the primary upper tract imaging in these subjects. |
Of this series, 840 (83%) had visible haematuria, 158 (15%) had microscopic or chemical haematuria and 9 (0.9%) had unspecified haematuria. A total of 133 bladder transitional cell tumours, 21 renal cell cancers and 2 upper tract transitional cell cancers (TCC) were diagnosed. The sensitivity of ultrasound with respect to bladder cancer was 63% and the specificity 99%. The odds ratio of diagnosing cancer in patients with visible haematuria compared to microscopic or unspecified haematuria was 3.3. No upper tract tumours were missed using this investigational protocol. |
4 |
| 66. Fang YC, Chou YH, Hsu CC, Chang T. Staging of bladder cancer by transabdominal real-time ultrasound. Zhonghua Yi Xue Za Zhi (Taipei). 1993;52(1):21-25. |
Observational-Dx |
214 patients staged for bladder cancer |
To stage TCCB with abdominal US vs pathological specimens. |
Overall accuracy 78.5%; 9.8% overstaging; 11.7% understaging: stage A=87%, stage B=60.5% (23/38); stage C=41.2% (7/17) and stage D=83.3% (10/12). There was no strong correlation between tumor grading and staging, except that most of the grade I lesions were at stage A (30/31, 97%). The preoperative local staging of urinary bladder cancer by real-time US might be of great value to determine the management planning and prognosis of the patients. |
3 |
| 67. Ozden E, Turgut AT, Yesil M, Gogus C, Gogus O. A new parameter for staging bladder carcinoma: ultrasonographic contact length and height-to-length ratio. J Ultrasound Med. 2007;26(9):1137-1142. |
Observational-Dx |
57 patients |
To investigate the value of tumor-bladder wall contact length, tumor height, and height-to-length ratio for preoperative staging of bladder carcinoma. |
Statistically significant differences were found for contact length and height-to-length ratio between superficial and invasive tumor groups. These parameters were also effective for differentiating superficial or deep muscle invasion. The US measurements of contact length of the tumor with the bladder wall and height-to-length ratio may be useful for staging bladder carcinoma by verification of these findings in larger groups of patients. |
3 |
| 68. Wagner B, Nesslauer T, Bartsch G, Jr., Hautmann RE, Gottfried HW. Staging bladder carcinoma by three-dimensional ultrasound rendering. Ultrasound Med Biol. 2005;31(3):301-305. |
Observational-Dx |
63 patients |
To assess value and limitations of 3D US rendering in bladder cancer staging. |
Superficial tumors correctly staged in 66% of cases; lamina propria invasive tumors correctly staged in 83% of cases; muscle invasive tumors correctly staged in 100% of cases; overall accuracy was 79%. 3Dl US rendering is most valuable to discriminate between superficial stages pT1. This new technique might improve staging of bladder cancer. |
3 |
| 69. Park HJ, Hong SS, Kim JH, et al. Tumor detection and serosal invasion of bladder cancer: role of three-dimensional volumetric reconstructed US. Abdom Imaging. 35(3):265-70, 2010 Jun. |
Observational-Dx |
14 patients |
To evaluate the accuracy of 3D volumetric reconstructed US in the assessment of tumor detection and serosal invasion in patients with bladder cancer. |
The sensitivity of preoperative tumor staging was 67.9% for 2D US and sensitivity was 78.6% for 3D US. 3D US was superior sensitivity than 2D US (P < 0.05). The accuracy for serosal invasion in staging of bladder cancer was demonstrated for 88.9% in 2D US and for 100% in 3D US. The accuracy for serosal invasion (T3b) in the staging of bladder cancer was demonstrated for 88.9% in 2D US and for 100% in 3D US. 3D volumetric reconstructed US is a non-invasive and accurate technique for tumor detection of bladder cancer. |
2 |
| 70. Li QY, Tang J, He EH, et al. Clinical utility of three-dimensional contrast-enhanced ultrasound in the differentiation between noninvasive and invasive neoplasms of urinary bladder. Eur J Radiol 2012;81:2936-42. |
Observational-Dx |
60 lesions in 60 consecutive patients |
To evaluate the effectiveness of three-dimensional contrast-enhanced ultrasound in differentiating invasive and noninvasive neoplasms of urinary bladder. |
Final pathologic staging revealed 44 noninvasive tumors and 16 invasive tumors. Three-dimensional contrast-enhanced ultrasound depicted all 16 muscle-invasive tumors. The diagnostic performance of three-dimensional contrast-enhanced ultrasound was better than those of three dimensional ultrasonography and contrast enhanced ultrasonography. The receiver operating characteristic curves were 0.976 and 0.967 for three-dimensional contrast-enhanced ultrasound, those for three dimensional ultrasonography were 0.881 and 0.869, those for contrast enhanced ultrasonography were 0.927 and 0.929. The kappa values in the three dimensional ultrasonography, contrast enhanced ultrasonography and three-dimensional contrast-enhanced ultrasound for inter-reader agreements were 0.717, 0.794 and 0.914. |
2 |
| 71. Caruso G, Salvaggio G, Campisi A, et al. Bladder tumor staging: comparison of contrast-enhanced and gray-scale ultrasound. AJR Am J Roentgenol. 2010;194(1):151-156. |
Observational-Dx |
34 patients |
To evaluate the effectiveness of contrast-enhanced sonography in comparison with conventional sonography in differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder. |
Final pathologic staging revealed 25 superficial tumors (Ta-T1 disease) and nine muscle-infiltrating tumors (>T1). Conventional sonography depicted five of nine muscle-infiltrating tumors, and contrast-enhanced sonography depicted all nine. The diagnostic performance of contrast-enhanced sonography approached that of the reference standard (area under the receiver operating characteristic curve, 0.996), but the diagnostic performance of gray-scale US was worse (area under curve, 0.613). Study showed that contrast-enhanced sonography is better than conventional sonography for differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder. |
2 |
| 72. Ge X, Lan ZK, Chen J, Zhu SY. Effectiveness of contrast-enhanced ultrasound for detecting the staging and grading of bladder cancer: a systematic review and meta-analysis. Med. ultrasonography. 23(1):29-35, 2021 Feb 18. |
Meta-analysis |
5 studies and 436 patients |
To retrospectively analyze the accuracy of preoperative contrast-enhanced ultrasound (CEUS) in differenti-ating stage Ta-T1 or low-grade bladder cancer (BC) from stage T2 or high-grade bladder cancer. |
The pooled-sensitivity (P-SEN), pooled-specificity (P-SPE), pooled-positive likelihood ratio (PLR+), pooled-negative likelihood ratio (PLR-), DOR, and area under the SROC curve were 94.0% (95%CI: 85%-98%), 90% (95%CI: 83%-95%), 9.5 (95%CI: 5.1-17.6), 0.06 (95%CI: 0.02-0.17), 147 (95%CI: 35-612) and 97% (95% CI: 95%-98%) respectively. |
Good |
| 73. Li C, Gu Z, Ni P, et al. The value of contrast-enhanced ultrasound and magnetic resonance imaging in the diagnosis of bladder cancer. J Cancer Res Ther. 17(5):1179-1185, 2021 Nov. |
Observational-Dx |
59 patients |
To assess the value of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) in the diagnosis of BC. |
The accuracies of CEUS and MRI + DWI examination for T staging of BC were 74.6% and 76.3%, respectively. Compared with the single diagnostic methods, the two combined diagnosis accuracy was 91.5%, which was significantly improved in diagnosis accuracy (P < 0.05). The diagnostic accuracies of CEUS, MRI + DWI, and ADC for muscle invasion of BC were 81.4%, 83.1%, and 84.7%, respectively. The diagnostic accuracy of CEUS parallel combined with MRI + DWI (91.5%) was obviously enhanced, compared with that with the single diagnostic method. |
3 |
| 74. Kuroda M, Meguro N, Maeda O, et al. Stage specific follow-up strategy after cystectomy for carcinoma of the bladder. Int J Urol. 2002;9(3):129-133. |
Observational-Dx |
351 patients |
To develop a stage specific follow-up strategy after cystectomy for bladder cancer. |
The risk of metastases was related to the pathologic stage of the primary tumor. Recurrences in patients with pT3 or higher were found earlier and more frequently than those with pT2 or lower. A stage-driven follow-up strategy for monitoring patients after radical cystectomy can reduce medical expenses while efficiently detecting recurrences and complications. |
4 |
| 75. Brismar J, Gustafson T. Bone scintigraphy in staging of bladder carcinoma. Acta Radiol. 1988;29(2):251-252. |
Observational-Dx |
71 consecutive cases 458 staging bone scans |
To evaluate the efficacy of bone scanning in staging of bladder cancer. |
4.6% positive (2.8% true, 1.7% false). In only four (0.9%) was surgery avoided because of the results, “scintigraphy thus has no place in the routine preoperative staging of bladder carcinoma”. |
4 |
| 76. Braendengen M, Winderen M, Fossa SD. Clinical significance of routine pre-cystectomy bone scans in patients with muscle-invasive bladder cancer. Br J Urol. 1996;77(1):36-40. |
Observational-Dx |
91 patients |
To evaluate the clinical significance of bone scans taken routinely before total cystectomy in patients with bladder cancer of clinical stage =T2. |
Of the 91 patients, 37 (41%) developed skeletal bone metastases after cystectomy, unrelated to the clinical T category. In 35 patients, the pre-cystectomy bone scan showed pathological uptake of isotope which was interpreted by the specialist in nuclear medicine as suspicious of (13 patients) or probably caused by (22 patients) skeletal metastases. In either circumstance, the clinician decided that total cystectomy was precluded, particularly as most of the changes could be explained radiologically as being degenerative.In the individual patient, there was no clinically useful correlation between the findings on the precystectomy bone scan and the clinical course of disease, nor if serum alkaline phosphatase level was included as an additional predictive factor. The findings of a routine preoperative bone scan are usually unable to identify patients with bladder cancer of stage =T2 who will not be cured by total cystectomy. Unless further investigations, particularly MRI, can be performed, the findings of a routine pre-operative bone scan are usually unable to identify patients with bladder cancer of stage > or = T2 who will not be cured by total cystectomy. |
3 |
| 77. Ghorbani H, Soltani S, Zakavi SR, et al. Bone scan with technetium 99m-methyl diphosphonate, the missing link in the initial staging of muscle-invasive bladder carcinoma. Nucl Med Commun. 43(6):675-679, 2022 Jun 01. |
Observational-Dx |
45 patients |
To assess the role of bone scan in the initial staging of muscle-invasive bladder carcinoma (MIBC). |
Frequency of skeletal metastasis was 26.7%. Only 19% of the metastases were detected by previous pelvic CT/MRI images performed for routine staging. All the reported skeletal metastases by previous anatomical imaging methods were detected in the bone scan. There was no statistically significant correlation between bone metastasis and the patient's age, lymph nodes metastasis (LNM), hydronephrosis, and muscle-invasive type. The mean serum calcium level was 8.7 ± 0.57 in patients with bone metastasis and 8.87 ± 0.99 in patients without bone metastasis, which was not statistically significant. |
2 |
| 78. Taher AN, Kotb MH. Bone metastases in muscle-invasive bladder cancer. J. Egypt. Natl. Cancer Inst.. 18(3):203-8, 2006 Sep. |
Observational-Dx |
179 patients |
To address the necessity of incorporating isotopic bone scan in the routine staging work-up of muscle invasive bladder cancer patients, the authors analyzed the data in their files to determine the incidence of bone metastasis in such patients. The rate of subsequent development of bone metastasis along the natural history of the disease was also investigated. |
Amongst the 179 patients, 26 (14.5%) had bone metastasis on presentation, a finding that showed a statistically significant correlation with the increasing depth of muscle invasion; 61.5% of the metastatic cases had deep muscle invasion,19.2% had superficial muscle invasion and there was no muscle invasion in 7.7% (p=0.000). Transitional cell carcinoma was the pathology in 92.3% of those patients, while only 7.7% had squamous cell carcinoma (p=0.036). The cumulative 3-year incidence of bone-metastasis in the non metastatic patients after treatment mounted to 19.4 +/- 4.4%. The cumulative 3-year bone metastasis incidence in the 153 patients was higher with increasing clinical stage; 8.4 +/- 8% for c-stage 2 and 49.1 +/- 18.5% for c-stage 4 (p=0.046). As for the p-category of the tumor in the 130 patients who underwent operation, the incidence increased with higher p-stages (p=0.006). Though pelvic nodal involvement was not associated with statistically significant increase in the incidence of bone metastases, yet when incorporated as one of the 3 risk factors (grade>3, p (3) 4a and lymph node positive at surgery) according to which patients were grouped, there was a statistically significant difference in the incidence between patients with no risk factors, only 1 and 2 or more factors (p=0.021). CONCLUSION: Meticulous search for bone metastasis alone or as a component of distant failure in the newly diagnosed bladder cancer patients is crucial to offer them the proper management and avoid undue radical surgical procedures. Thus bone scan is suggested to be performed routinely in patients with evidence of muscle invasion. |
4 |
| 79. Maganty A, Turner RM 2nd, Yabes JG, Davies BJ, Heron DE, Jacobs BL. Downstream Studies Following the Use of Bone Scan in the Staging of Muscle-invasive Bladder Cancer. Urology. 129:74-78, 2019 Jul. |
Review/Other-Dx |
4404 patients |
To quantify the use of downstream studies following staging bone scans in patients with muscle-invasive bladder cancer. |
Among patients diagnosed with muscle-invasive bladder cancer, 1373 (31%) had a staging bone scan of whom 26% received a downstream study (n = 213). Overall, 61 patients (7%) received downstream bone-specific X-rays, more than 141 patients (>17%) received bone-specific CTs, and 28 patients (3%) received bone-specific MRIs. The use of bone biopsy was rare (n < 11; <1%). The total cost of all downstream studies was $103,468. Furthermore, there was a one-month delay in treatment for those who received a downstream study compared to those who did not (P < 0.001). |
4 |
| 80. Furrer MA, Grueter T, Bosshard P, et al. Routine Preoperative Bone Scintigraphy Has Limited Impact on the Management of Patients with Invasive Bladder Cancer. Eur Urol Focus. 7(5):1052-1060, 2021 Sep. |
Observational-Dx |
1287 consecutive patients |
To assess the clinical impact of routine staging bone scintigraphy on further patient management. |
Of 1287 patients scheduled for radical cystectomy, 1148 (89%) underwent bone scintigraphy as staging imaging. Overall, baseline bone scintigraphy led to a change in the intended management in 19/1148 (1.7%) patients. Additional imaging was performed in 44/1148 (4%) patients. Although positive bone scintigraphy findings were associated with the occurrence/development of bone metastases, the diagnostic performance of baseline bone scintigraphy was generally poor (positive predictive value, negative predictive value, sensitivity, and specificity were 56%, 89%, 27%, and 96%, respectively). Higher clinical tumor stage and the nonperformance of cystectomy had negative impacts on cancer-specific survival and overall survival, while positive bone scintigraphy was associated with worse cancer-specific survival. |
3 |
| 81. Lee CH, Tan CH, Faria SC, Kundra V. Role of Imaging in the Local Staging of Urothelial Carcinoma of the Bladder. [Review]. AJR Am J Roentgenol. 208(6):1193-1205, 2017 Jun. |
Review/Other-Dx |
N/A |
To review imaging modalities used in local staging of bladder urothelial carcinoma. |
No results stated in abstract. |
4 |
| 82. Xu Y, Lou J, Gao Z, Zhan M. Computed Tomography Image Features under Deep Learning Algorithm Applied in Staging Diagnosis of Bladder Cancer and Detection on Ceramide Glycosylation. Comput. math. methods med.. 2022:7979523, 2022. |
Observational-Dx |
60 patients |
To investigate computed tomography (CT) image based on deep learning algorithm and the application value of ceramide glycosylation in diagnosing bladder cancer. |
The comparison results found that, in simple CT clinical staging, the coincidence rates of T1 stage, T2a stage, T2b stage, T3 stage, and T4 stage were 28.56%, 62.51%, 78.94%, 84.61%, and 74.99%, respectively; and the total coincidence rate of CT clinical staging was 63.32%, which was greatly different from the clinical staging of pathological diagnosis (P < 0.05). In the clinical staging of algorithm-based CT test results, the coincidence rates of T1 stage and T2a stage were 50.01% and 91.65%, respectively; and those of T2b stage, T3 stage, and T4 stage were 100.00%; and the total coincidence rate was 96.69%, which was not obviously different from the clinical staging of pathological diagnosis (P > 0.05). |
3 |
| 83. Crozier J, Papa N, Perera M, et al. Comparative sensitivity and specificity of imaging modalities in staging bladder cancer prior to radical cystectomy: a systematic review and meta-analysis. World J Urol. 37(4):667-690, 2019 Apr. |
Meta-analysis |
35 articles |
To investigate the utility of alternate imaging modalities on pre-cystectomy imaging in bladder cancer for the detection of lymph node metastases. |
MRI and PET have a higher sensitivity than CT while the specificity of all modalities was similar. The summary MRI sensitivity = 0.60 (95% CI 0.44-0.74) and specificity = 0.91 (95% CI 0.82-0.96). Summary PET/CT sensitivity = 0.56 (95% CI 0.49-0.63) and specificity = 0.92 (95% CI 0.86-0.95). Summary CT sensitivity = 0.40 (95% CI 0.33-0.49) and specificity = 0.92 (95% CI 0.86-0.95). |
Good |
| 84. Girard A, Vila Reyes H, Shaish H, et al. The Role of 18F-FDG PET/CT in Guiding Precision Medicine for Invasive Bladder Carcinoma. [Review]. Front. oncol.. 10:565086, 2020. |
Review/Other-Dx |
N/A |
To highlight current literature reporting the role of 18F-FDG PET in supporting personalized management decisions for patients with MIBC. |
No results stated in abstract. |
4 |
| 85. Moussa M, Chakra MA, Saad W, Dellis A, Papatsoris A. The role of 18F-FDG PET/CT scan compared to CT-scan alone for lymph node staging before radical cystectomy in patients with bladder cancer. UROL. ONCOL.. 39(12):833.e9-833.e17, 2021 12. |
Observational-Dx |
300 patients |
To evaluate the diagnostic value of PET-CT scan, compared with CT scan alone for preoperative LN staging of BC. |
On a patient-based analysis, PET–CT, and CT showed a sensitivity of 40.3% and 13.4 %, respectively, a specificity of 79.5% and 86.7 %, respectively, positive predictive value (PPV) of 61.4% and 45%, respectively, and negative predictive value (NPV) of 62.3% and 55.4%, respectively. |
2 |
| 86. Yuan JB, Zu XB, Miao JG, Wang J, Chen MF, Qi L. Laparoscopic pelvic lymph node dissection system based on preoperative primary tumour stage (T stage) by computed tomography in urothelial bladder cancer: results of a single-institution prospective study. BJU Int 2013;112:E87-91. |
Observational-Tx |
63 Patients |
To study prospectively the clinical value of preoperative spiral computed tomography (CT) staging of primary tumours in deciding the extent of pelvic lymph node dissection (PLND) during laparoscopic radical cystectomy (RC) in the management of bladder cancer (BC). |
All patients were divided into five categories according to their CTx stages: three at CT1, seven at CT2a, 38 at CT2b, seven at CT3b, and eight at CT4a. All 63 procedures were completed successfully without any conversion to open surgery. The mean estimated blood loss was 450 mL, and 14 patients (22.2%) had postoperative lymphatic leakage. Each case was pathologically confirmed as transitional cell carcinoma with negative margins at the urethral and ureteric stumps. None of the patients with a low CTx stage (CT1-CT2a) had positive lymph nodes above the level of the common iliac artery bifurcation. There was no jump lymph node metastasis, and no positive lymph node was detected above the level of aortic bifurcation in all cases. |
3 |
| 87. Horn T, Zahel T, Adt N, et al. Evaluation of Computed Tomography for Lymph Node Staging in Bladder Cancer Prior to Radical Cystectomy. Urol Int 2016;96:51-6. |
Observational-Dx |
231 Patients |
To retrospectively evaluate the value of CT for lymph node (LN) staging in bladder cancer. |
LN metastases were found in 59 of 231 patients (25.5%). On a patient-based level, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 52.6, 93.6, 73.2, 85.6 and 83.4%, respectively. Using the field-based approach, a total of 1,649 anatomical fields were evaluable, of which 114 fields showed malignancy (6.9%). On a field basis, sensitivity, specificity, PPV, NPV and accuracy were 30.2, 98, 51.5, 94.5 and 93.3%, respectively. Concerning local staging (pT category), the overall accuracy was 78%; overstaging occurred in 6% and understaging in 16%. |
2 |
| 88. Turkbey B, Basaran C, Karcaaltincaba M, et al. Peritoneal carcinomatosis in urinary bladder cancer. Clin Imaging. 2008;32(3):192-195. |
Review/Other-Dx |
105 patients scanned |
To describe the CT findings of peritoneal carcinomatosis of urinary bladder cancer origin. |
8 patients (7.6%) of 105 CT scans showed evidence of peritoneal carcinomatosis. Presence of peritoneal carcinomatosis in cancer patients is an indicator of poor prognosis. Detection of peritoneal involvement in urinary bladder cancer patients can alter treatment strategy and may prevent unnecessary aggressive surgical interventions. |
4 |
| 89. Browne RF, Meehan CP, Colville J, Power R, Torreggiani WC. Transitional cell carcinoma of the upper urinary tract: spectrum of imaging findings. [Review] [45 refs]. Radiographics. 25(6):1609-27, 2005 Nov-Dec. |
Review/Other-Dx |
N/A |
To review the characteristic imaging features of upper tract TCC and outlines the role of imaging in diagnosis, preoperative staging, and follow-up. |
No results stated in abstract. |
4 |
| 90. Goodfellow H, Viney Z, Hughes P, et al. Role of fluorodeoxyglucose positron emission tomography (FDG PET)-computed tomography (CT) in the staging of bladder cancer. BJU Int 2014;114:389-95. |
Observational-Dx |
233 Patients |
To determine whether to use (18) F-fluorodeoxyglucose positron emission tomography (FDG PET) scans in the preoperative staging of bladder cancer (BC). |
The PET scan was able to detect metastatic disease outside of the pelvis with a sensitivity of 54% compared with 41% for the staging CT (N = 207). Both scans had similar specificities of 97% and 98%. There were 13 PET avid lesions not visualised on the corresponding staging CT scans. These proved to be metastatic BC (six patients), a synchronous primary colonic cancer (one), colonic adenomas (one), basal cell tumour of the parotid gland (one) and inflammatory lesions (four). The sensitivity and specificity of the CT scans for pelvic LN involvement was 45% and 98%, respectively (N = 93). Using a combination of the PET and CT scan, the sensitivity for detecting metastatic disease in LNs increased to 69% with a 3% reduction in specificity to 95%. |
2 |
| 91. Nayak B, Dogra PN, Naswa N, Kumar R. Diuretic 18F-FDG PET/CT imaging for detection and locoregional staging of urinary bladder cancer: prospective evaluation of a novel technique. Eur J Nucl Med Mol Imaging 2013;40:386-93. |
Observational-Dx |
25 Patients |
To evaluate the potential application of diuretic (18)F-FDG PET/CT in improving detection and locoregional staging of urinary bladder tumours. |
Of the 25 patients, CECT detected a primary tumour in 23 (sensitivity 92 %), while (18)F-FDG PET/CT was positive in 24 patients (sensitivity 96 %). Mean size and maximum standardized uptake value of the bladder tumours were 3.33 cm (range 1.6-6.2) and 5.3 (range 1.3-11.7), respectively. Of the 25 patients, only 10 patients underwent radical cystectomy based on disease status on TURBT. Among those ten patients, nine had locoregional metastases. Among the nine patients who had positive lymph nodes for metastasis on histopathology, CECT and PET/CT scan had a sensitivity of 44 and 78 %, respectively. (18)F-FDG PET/CT was found to be superior to CECT in the detection of the primary tumour and locoregional staging (p < 0.05). |
1 |
| 92. Soubra A, Hayward D, Dahm P, et al. The diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography and computed tomography in staging bladder cancer: a single-institution study and a systematic review with meta-analysis. World J Urol 2016;34:1229-37. |
Observational-Dx |
78 Patients |
To assess the diagnostic accuracy of 18F-fluorodeoxyglucose with positron emission tomography and computed tomography (FDG-PET-CT) to predict nodal metastases in patients with bladder cancer (BC) scheduled to undergo radical cystectomy (RC). |
For detecting nodal metastases in 78 patients, the sensitivity of FDG-PET-CT was 0.56 (95 % CI 0.29-0.80) and the specificity, 0.98 (95 % CI 0.91-1.00). Pooled sensitivity and specificity for detecting lymph node metastasis were 0.57 and 0.95, respectively. Positive likelihood ratio was 9.02. All lesions that were suspicious for distant metastasis were found to be positive on biopsy. |
2 |
| 93. Pichler R, De Zordo T, Fritz J, et al. Pelvic Lymph Node Staging by Combined 18F-FDG-PET/CT Imaging in Bladder Cancer Prior to Radical Cystectomy. Clin Genitourin Cancer. 15(3):e387-e395, 2017 06. |
Observational-Dx |
70 Patients |
To evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) alone, or combined for preoperative pelvic LN staging. |
Metastatic LNs were confirmed in 53 (2.8%) of 1906 resected LNs in 11 (15.7%) patients. Sensitivity, specificity, and accuracy were 54.5%, 89.8%, and 84.3% for 18F-FDG-PET alone; 45.5%, 91.5%, and 84.3% for CT (LNs > 8 mm) alone; and 27.3%, 96.6%, and 85.7% for CT (LNs > 10 mm) alone, respectively. Combined 18F-FDG-PET/CT resulted in a nonsignificant increase of diagnostic accuracy using a cutoff > 8 mm for LN evaluation (63.6%, 86.4%, and 82.9%, respectively). A significant improvement of sensitivity to 63.6% was achieved only when LNs > 10 mm were considered suspicious (P = .046), but this reduced specificity to 88.1% (P = .025). |
2 |
| 94. Girard A, Rouanne M, Taconet S, et al. Integrated analysis of 18F-FDG PET/CT improves preoperative lymph node staging for patients with invasive bladder cancer. Eur Radiol. 29(8):4286-4293, 2019 Aug. |
Observational-Dx |
61 patients |
To compare the accuracy of FDG PET/CT to CT alone for preoperative regional LN staging in patients with MIBC. |
1012 LNs were identified in 61 patients with clinically localized invasive bladder cancer who underwent radical cystectomy and extended pelvic LN dissection. Loco-regional involvement of 24 LN areas was confirmed in 17 patients. In per area analysis, diagnostic accuracy of PET/CT and CT alone were respectively 84% and 78% (p = 0.039). On patient-based analysis, combined PET/CT correctly classified pelvic LN status in 5/61 (+ 8%) additional patients using optimal thresholds compared to CT alone, with accuracies of 82% and 74%, respectively (p = 0.13). |
3 |
| 95. Lu YY, Chen JH, Liang JA, et al. Clinical value of FDG PET or PET/CT in urinary bladder cancer: a systemic review and meta-analysis. [Review]. Eur J Radiol. 81(9):2411-6, 2012 Sep. |
Meta-analysis |
6 studies |
to conduct a systemic review and meta-analysis of the published literature to evaluate the diagnostic accuracy of FDG PET or PET/CT in urinary bladder cancer. |
The pooled sensitivity and specificity of PET/CT for primary lesion detection of bladder cancer were 0.90 (95% CI: 0.70-0.99) and 1.00 (95% CI: 0.74-1.00), respectively. The pooled sensitivity and specificity of FDG PET or PET/CT for staging or restaging (metastatic lesions) of bladder cancer were 0.82 (95% CI: 0.72-0.89) and 0.89 (95% CI: 0.81-0.95), respectively. |
Good |
| 96. 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 |
| 97. Apolo AB, Riches J, Schoder H, et al. Clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in bladder cancer. J Clin Oncol. 2010;28(25):3973-3978. |
Observational-Dx |
57 patients |
To investigate the value of FDG-PET/CT imaging in the management of patients with advanced bladder cancer. |
135 individual lesions were evaluable in 47 patients for the organ-based analysis. Overall sensitivity and specificity were 87% (95% CI, 76% to 94%) and 88% (95% CI, 78% to 95%), respectively. In the patient-based analysis, malignant disease was correctly diagnosed in 25 of 31 patients, resulting in a sensitivity of 81% (95% CI, 63% to 93%). FDG-PET/CT was negative in 15 of 16 patients without malignant lesions for a specificity of 94% (95% CI, 71% to 100%). Pre- and post-PET surveys revealed that FDG-PET/CT detected more malignant disease than conventional CT/MRI in 40% of patients. Post-PET surveys showed that clinicians changed their planned management in 68% of patients based on the FDG-PET/CT results. FDG-PET/CT has excellent sensitivity and specificity in the detection of metastatic bladder cancer and provides additional diagnostic information that enhances clinical management more than CT/MRI alone. FDG-PET/CT scans may provide better accuracy in clinical information for directing therapy. |
3 |
| 98. Kollberg P, Almquist H, Blackberg M, et al. [(18)F]Fluorodeoxyglucose - positron emission tomography/computed tomography improves staging in patients with high-risk muscle-invasive bladder cancer scheduled for radical cystectomy. Scand J Urol 2015;49:296-301. |
Review/Other-Dx |
103 Patients |
To evaluate the clinical use of [(18)F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in addition to conventional preoperative radiological investigations in a defined group of patients with high-risk muscle-invasive bladder cancer. |
Compared to CT alone, FDG-PET/CT provided more supplemental findings suggesting malignant manifestations in 48 (47%) of the 103 patients. The additional FDG-PET/CT findings led to an altered provisional treatment plan in 28 out of 103 patients (27%), detection of disseminated bladder cancer and subsequent cancellation of the initially intended cystectomy in 16 patients, and identification of disseminated disease and treatment with induction chemotherapy before radical cystectomy in 12 patients. |
4 |
| 99. Mertens LS, Fioole-Bruining A, Vegt E, Vogel WV, van Rhijn BW, Horenblas S. Impact of (18) F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) on management of patients with carcinoma invading bladder muscle. BJU Int 2013;112:729-34. |
Review/Other-Tx |
96 Patients |
To evaluate the clinical impact of (18) F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) scanning, compared with conventional staging with contrast-enhanced CT imaging (CECT). |
The median (range) interval between CECT and FDG-PET/CT was 0 (029) days. In 21.9% of the patients, stage on FDG-PET/CT and CECT were different. Upstaging by FDG-PET/CT was more frequent than downstaging (19.8 vs 2.1%). Clinical management changed for 13.5% of patients as a result of FDG-PET/CT upstaging. In eight patients, FDG-PET/CT detected second primary tumours. This led to changes of bladder cancer treatment in another four of 96 patients (4.2%). All the management changes were validated by tissue confirmation of the additional lesions. |
4 |
| 100. Voskuilen CS, van Gennep EJ, Einerhand SMH, et al. Staging 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Changes Treatment Recommendation in Invasive Bladder Cancer. Eur Urol Oncol. 5(3):366-369, 2022 06. |
Observational-Dx |
711 consecutive patients |
To evaluate the incremental value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) after standard conventional staging, in the largest cohort of MIBC patients to date. |
We recorded the clinical stage before and after FDG-PET/CT and treatment recommendation based on the stage before and after FDG-PET/CT. Clinical stage changed after FDG-PET/CT in 184/711 (26%) patients. Consequently, the recommended treatment strategy based on imaging changed in 127/711 (18%) patients. In 65/711 (9.1%) patients, potential curative treatment changed to palliative treatment because of the detection of distant metastases by FDG-PET/CT. Fifty (7.0%) patients were selected for neoadjuvant/induction chemotherapy based on FDG-PET/CT. Moreover, FDG-PET/CT detected lesions suspicious for second primary tumors in 15%; a second primary malignancy was confirmed in 28/711 (3.9%), leading to treatment change in ten (1.4%) patients. Contrarily 57/711 (8.1%) had false positive secondary findings. In conclusion, FDG-PET/CT provides important incremental staging information, which potentially influences clinical management in 18% of MIBC patients, but leads to false positive results as well. |
3 |
| 101. Bertolaso P, Brouste V, Cazeau AL, et al. Impact of 18 FDG- PET CT in the Management of Muscle Invasive Bladder Cancer. Clin Genitourin Cancer. 20(3):297-297.e6, 2022 06. |
Observational-Dx |
85 patients |
To assess the accuracy of the FDG-PET CT for LN staging and to determine the rate of treatment modification according to FDG-PET CT results in MIBC. |
Accuracy of LN staging from CT and FDG-PET CT at initial diagnosis was analyzed in 85 patients (including 70 patients treated with neoadjuvant chemotherapy (NAC)) and compared to pathological examination of resected LN. Sensitivity of FDG-PET CT was better than CT (80.8% versus 26.9%) but the specificity was low (54.2% vs. 83.1%). The Youden index was better for FDG-PET CT (0.35; 0.1 for CT) and FDG-PET CT appeared to be more accurate for determining LN staging of MIBC. FDG-PET CT findings enabled a treatment decision modification in 34/130 patients (26.1%): a therapeutic intensification (9.2%), including surgery not previously planned and/or modified fields of radiotherapy; or a de-escalation (16.9%), mostly avoiding surgery. |
3 |
| 102. 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 |
| 103. Brunocilla E, Ceci F, Schiavina R, et al. Diagnostic accuracy of (11)C-choline PET/CT in preoperative lymph node staging of bladder cancer: a systematic comparison with contrast-enhanced CT and histologic findings. Clin Nucl Med 2014;39:e308-12. |
Observational-Dx |
26 Patients |
To evaluate the role of C-choline PET/CT in the preoperative evaluation of the nodal involvement of patients with bladder carcinoma (BC) suitable for radical cystectomy and extended pelvic lymph node dissection in comparison with contrast-enhanced CT (CECT) using the pathologic specimen as reference standard. |
Seven of 26 patients (26.9%) showed nodal metastases at pathologic analysis. Overall, 844 LNs were evaluated, and 38 of them (4.5%) showed metastatic involvement. On a patient-based analysis, C-choline PET/CT showed a sensitivity of 42% and specificity of 84%, whereas, CECT showed a sensitivity of 14% and specificity of 89%. On a region-based analysis, C-choline PET/CT showed a sensitivity of 11% and specificity of 82%, whereas CECT showed a sensitivity of 5% and specificity of 80%. On a lesion (LN)-based analysis, C-choline PET/CT showed a sensitivity of 10% and specificity of 64%, whereas CECT showed a sensitivity of 2% and specificity of 63%. |
3 |
| 104. Ceci F, Bianchi L, Graziani T, et al. 11C-choline PET/CT and bladder cancer: lymph node metastasis assessment with pathological specimens as reference standard. Clin Nucl Med 2015;40:e124-8. |
Observational-Dx |
59 Patients |
To evaluate the potential role of C-choline-PET/CT in nodal assessment in patients with bladder cancer (BCa) using the pathological specimen as reference standard. |
C-choline-PET/CT overall detection rate was 62.7% (37/59 patients). On a regional-based analysis, C-choline-PET/CT was considered positive for primary cancer and/or local relapse in bladder bed in 54.2% of the patients (32/59). Pathological LN uptake was reported in 23.7% of the patients (14/59) and systemic choline deposit (bone or lung) in 11.8% of the patients (7/59). Considering LN metastasis detection, compared with histological analysis, C-choline-PET/CT showed in the whole population a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 59%, 90%, 71%, 84%, and 81%, respectively. No other investigated factors reached statistical significance. |
3 |
| 105. Golan S, Sopov V, Baniel J, Groshar D. Comparison of 11C-choline with 18F-FDG in positron emission tomography/computerized tomography for staging urothelial carcinoma: a prospective study. J Urol 2011;186:436-41. |
Observational-Tx |
20 Patients |
To compare the value of using 11C-choline with the well investigated 18F-FDG tracer in this setting. |
A total of 51 lesions showed abnormal tracer activity. The positive predictive value for all detected lesions was 84.7% for 11C-choline positron emission tomography/computerized tomography and 90.7% for 18F-FDG positron emission tomography/computerized tomography. The corresponding positive predictive values for extravesical lesions were 79.4% and 88.2%, respectively. Discrepant findings between the tracers were noted at 11 sites. 18F-FDG positron emission tomography/computerized tomography correctly identified 4 extravesical metastases missed by choline positron emission tomography/computerized tomography in the absence of a contrary observation. Mean maximum standardized uptake and lesion-to-background ratio at extravesical sites were significantly higher for FDG. |
2 |
| 106. Caglic I, Panebianco V, Vargas HA, et al. MRI of Bladder Cancer: Local and Nodal Staging. [Review]. J Magn Reson Imaging. 52(3):649-667, 2020 09. |
Review/Other-Dx |
N/A |
To review the current state of evidence supporting MRI in local, regional, and distant staging in patients with bladder cancer. |
No results stated in abstract. |
4 |
| 107. 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 |
| 108. Kobayashi S, Koga F, Yoshida S, et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in bladder cancer: potential utility of apparent diffusion coefficient values as a biomarker to predict clinical aggressiveness. Eur Radiol 2011;21:2178-86. |
Observational-Dx |
104 Patients |
To investigate the diagnostic performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in bladder cancer and the potential role of apparent diffusion coefficient (ADC) values in predicting pathological bladder cancer phenotypes associated with clinical aggressiveness. |
In detecting patients with bladder cancer, DW-MRI exhibited high sensitivity equivalent to that of T2W-MRI (>90%). Interobserver agreement was excellent for DW-MRI (kappa score, 0.88) though moderate for T2W-MRI (0.67). ADC values were significantly lower in high-grade (vs. low-grade, P < 0.0001) and high-stage (T2 vs. T1 vs. Ta, P < 0.0001) tumours. At a cut-off ADC value determined by partition analysis, clinically aggressive phenotypes including muscle-invasive bladder cancer (MIBC) and high-grade T1 disease were differentiated from less aggressive phenotypes with a sensitivity of 88%, a specificity of 85% and an accuracy of 87%. |
2 |
| 109. 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 |
| 110. Wu LM, Chen XX, Xu JR, et al. Clinical value of T2-weighted imaging combined with diffusion-weighted imaging in preoperative T staging of urinary bladder cancer: a large-scale, multiobserver prospective study on 3.0-T MRI. Acad Radiol 2013;20:939-46. |
Observational-Dx |
362 Patients |
To prospectively assess the incremental value of diffusion-weighted imaging (DWI) combined with T2-weighted images (T2WI) in determining the T stage of bladder cancer by using pathologic findings as the reference standard. |
For differentiating Tis to T1 tumors from T2 to T4 tumors, the AUCs for T2WI and DWI (0.97 for observer 1 and 0.96 for observer 2) were greater than those for the DWI alone (0.92 for observer 1 and 0.90 for observer 2) (P < .05). Observer 3 had similar AUCs for T2WI and DWI compared to DWI alone. The accuracy of T2WI and DWI (observer 1, 98%; observer 2, 96%; observer 3, 92%) was greater than that of DWI alone (observer 1, 92%; observer 2, 90%; observer 3, 87%) for all observers (P < .05). The specificity of T2WI and DWI (observer 1, 100%; observer 2, 98%; observer 3, 93%) was greater than that of DWI alone (observer 1, 92%; observer 2, 90%; observer 3, 87%) for all observers (P < .05). Sensitivity was not improved even when T2WI and DWI were used. For differentiating Tis to T2 Tumors from T3 to T4 Tumors, the overall accuracy, specificity, and AUC for diagnosing T2 or higher stages were not significantly improved by combiningT2WI and DWI. |
2 |
| 111. Razik A, Das CJ, Sharma S, et al. Diagnostic performance of diffusion-weighted MR imaging at 3.0 T in predicting muscle invasion in urinary bladder cancer: utility of evaluating the morphology of the reactive tumor stalk. Abdom Radiol. 43(9):2431-2441, 2018 09. |
Observational-Dx |
40 patients with 92 tumors were assessed. |
To evaluate the diagnostic performance of stalk morphology on diffusion-weighted imaging (DWI) in comparison with conventional MRI in predicting muscle invasion in urinary bladder cancer. |
All the evaluated features were present with significantly higher frequency in muscle-invasive tumors (p < 0.001). The finding of absent or distorted stalk on DWI had the highest sensitivity (87.5%) and specificity (97.6%). Conventional imaging features of non-papillary stalk morphology, restricted distension of underlying bladder wall, perivesical fat infiltration, as well as the previous DWI criterion were less sensitive (56.3%, 68.8%, 56.3% and 56.3%, respectively) in predicting muscle invasion. |
1 |
| 112. Barentsz JO, Ruijs SH, Strijk SP. The role of MR imaging in carcinoma of the urinary bladder. AJR Am J Roentgenol. 1993;160(5):937-947. |
Review/Other-Dx |
N/A |
To review the role of MRI in TCCB. |
MRI and clinical staging are complementary for staging urinary bladder cancer; in superficial tumors, clinical staging, including transurethral resection, is the best technique. For invasive tumors, MR imaging is the best technique for staging. |
4 |
| 113. Chlapoutakis K, Theocharopoulos N, Yarmenitis S, Damilakis J. Performance of computed tomographic urography in diagnosis of upper urinary tract urothelial carcinoma, in patients presenting with hematuria: Systematic review and meta-analysis. [Review] [17 refs]. Eur J Radiol. 73(2):334-8, 2010 Feb. |
Meta-analysis |
5 articles |
To review and meta-analyze published literature, in order to evaluate the performance of CTU for the detection of upper urinary tract urothelial tumors. |
CTU proved to be a very sensitive and specific method for the detection of urothelial malignancy, with sensitivity ranging between 88% and 100%, and specificity between 93% and 100%. Pooled sensitivity was 96% (95% CI: 88%–100%) and pooled specificity was 99% (95% CI: 98%–100%). Direct comparison of the method with IVU, confirmed the superiority of CTU over IVU in terms of sensitivity and specificity. Major drawbacks of CTU are increased radiation risk, injection of iodinated contrast media which may potentially be accompanied by serious side effects and increased cost, estimated as roughly 3 times that of IVU. |
M |
| 114. Fritz GA, Schoellnast H, Deutschmann HA, Quehenberger F, Tillich M. Multiphasic multidetector-row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract. Eur Radiol. 16(6):1244-52, 2006 Jun. |
Observational-Dx |
39 consecutive patients with 41 histologically verified TCC of the renal pelvis and/or the ureter. |
To evaluate the potential of multiphasic multidetector-row CT (MDCT) in the detection and staging of transitional cell carcinomas (TCC) of the upper urinary tract. |
In MDCT, all 41 TCC--including two multicentric TCC--were detected. TCC confined to the organ (stage 0a-II) was correctly staged in 28/29 tumors (96.6%). Stage III-IV tumors were correctly staged in 8/12 patients (66.6%). Overall, MDCT was accurate in predicting pathologic TNM stage in 36/41 upper urinary tract TCC (87.8%). There was no significant difference of mean attenuation of TCC between CMP, NP and PP (P > 0.05). MDCT with its high spatial and temporal resolution is an accurate tool for detection TCC of the upper urinary tract, with 87.8% accuracy in predicting its stage. |
3 |
| 115. Gandrup KL, Nordling J, Balslev I, Thomsen HS. Upper urinary tract tumors: how does the contrast enhancement measured in a split-bolus CTU correlate to histological staging?. Acta Radiol. 55(6):761-8, 2014 Jul. |
Observational-Dx |
69 patients |
To examine the value of CTU using split-bolus technique to distinguish non-invasive from invasive urothelial carcinomas in the upper urinary tract. |
istopathological examination revealed 31 patients with non-invasive and 38 with invasive urothelial carcinoma. Neither absolute attenuation nor change in attenuation values obtained at CTU could distinguish between invasive and non-invasive lesions. No patients had a CTU within the last year before the examination that resulted in surgery. |
2 |
| 116. Mammen S, Krishna S, Quon M, et al. Diagnostic Accuracy of Qualitative and Quantitative Computed Tomography Analysis for Diagnosis of Pathological Grade and Stage in Upper Tract Urothelial Cell Carcinoma. J Comput Assist Tomogr. 42(2):204-210, 2018 Mar/Apr. |
Observational-Dx |
48 patients with 49 UCC |
To compare grade and stage of upper tract urothelial cell carcinoma (UCC) using computed tomography. |
There was no difference in size of tumors compared by grade or stage (P = 0.80 and 0.13, respectively).Among subjective variables, only tumor texture was significantly different between low- and high-grade UCC (P = 0.03; ? = 0.45). Tumors characterized as spiculated/irregular margin (P = 0.003; 0.30) and heterogeneous (P < 0.001; ? = 0.45) were associated with T2 disease or higher.Entropy was greater in higher grade (6.23 ± 0.46 vs 5.72 ± 0.28) and T2 disease or higher (6.40 ± 0.33 vs 5.95 ± 0.48), (P = 0.03 and 0.02, respectively) with no differences in Kurtosis or Skewness (P > 0.05). Area under the receiver operator characteristic curve for entropy to diagnose high-grade and T2 tumors or higher was 0.83 (confidence interval, 0.64-1.0) and 0.79 (confidence interval 0.59-0.98), respectively. |
2 |
| 117. Honda Y, Nakamura Y, Teishima J, et al. Clinical staging of upper urinary tract urothelial carcinoma for T staging: Review and pictorial essay. [Review]. International Journal of Urology. 26(11):1024-1032, 2019 11. |
Review/Other-Dx |
N/A |
To discuss the staging of upper UTUCs using CTU. |
No results stated in abstract. |
4 |
| 118. Ito Y, Kikuchi E, Tanaka N, et al. Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma. J Urol. 185(5):1621-6, 2011 May. |
Observational-Dx |
91 patients |
To evaluate whether hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically. |
Preoperatively 67 patients (73.6%) had ipsilateral hydronephrosis. Grade was 1 to 4 in 3 (3.3%), 17 (18.7%), 23 (25.3%) and 24 cases (26.4%), respectively. Higher hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage (p = 0.0002) and lymphovascular invasion (p = 0.0014). Higher hydronephrosis grade was not associated with disease specific or metastasis-free survival. On preoperative multivariate analysis high hydronephrosis grade predicted pathological T stage (T3 or greater) (HR 4.98, p = 0.0228), positive lymphovascular invasion (HR 6.37, p = 0.0022) and grade 3 (HR 2.98, p = 0.0311). |
2 |
| 119. Yu SH, Hur YH, Hwang EC, et al. Does multidetector computed tomographic urography (MDCTU) T staging classification correspond with pathologic T staging in upper tract urothelial carcinoma?. Int Urol Nephrol. 53(1):69-75, 2021 Jan. |
Observational-Dx |
125 patients |
To compare the diagnostic accuracy of MDCTU T stage classification and pathologic T staging for UTUC. |
Among 85 pathologic low T stage (Ta-T2) tumors, 71 low T stage tumors were correctly detected by MDCTU, while 30 out of 40 advanced T stage (T3-T4) tumors were correctly diagnosed by MDCTU. MDCTU led to under-staging in 8% (10/125) tumors and over-staging in 11.2% (14/125) tumors. Therefore, the overall accuracy of MDCTU in the diagnosis of low and advanced T stage tumors was 80.8% (101/125 patients). The sensitivity for advanced T stage tumors was 75% (30/40), the specificity was 83.5% (71/85), and the positive and negative predictive values were 68.1% (30/44) and 87.6% (71/81), respectively. The kappa agreement value between the MDCTU T stage and pathologic T stage was 0.57 (95% confidence interval (CI) 0.42-0.72), which was statistically significant (P = 0.001). |
2 |
| 120. Li X, Li S, Chi Z, et al. Clinicopathological characteristics, prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma. UROL. ONCOL.. 39(1):75.e1-75.e8, 2021 01. |
Observational-Dx |
250 patients |
To investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC). |
There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs =3, no response to chemotherapy and cycles of chemotherapy =2 were adverse prognosticators for overall survival. |
4 |
| 121. Voskuilen CS, Schweitzer D, Jensen JB, et al. Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma. Eur Urol Oncol. 3(1):73-79, 2020 02. |
Observational-Dx |
117 patients |
To determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC. |
Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57-96) and 84% (95% CI: 71-94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. |
3 |
| 122. Kobayashi M, Tanaka H, Tateishi U, et al. Impact of fluorodeoxyglucose uptake on positron emission tomography/computed tomography on chemosensitivity and survival in patients with metastatic urothelial carcinoma. Int J Urol. 26(8):820-826, 2019 08. |
Review/Other-Dx |
51 metastatic urothelial carcinoma patients |
To evaluate the impact of fluorodeoxyglucose uptake on positron emission tomography/computed tomography on chemosensitivity and survival in patients with metastatic urothelial carcinoma. |
The Karnofsky performance status was =80% for all patients. Visceral metastasis was observed in 12 patients (24%). The objective response rate, median progression-free survival and median cancer-specific survival were 61%, 9 and 26 months in the entire cohort, respectively. The higher highest maximum standardized uptake value was significantly associated with a lower objective response rate, shorter progression-free survival and shorter cancer-specific survival (P = 0.01, <0.001 and 0.004, respectively). On multivariate analyses, the highest maximum standardized uptake value was an independent predictor for all end-points. In the multivariate models for cancer-specific survival, the C-index improved from 0.559 to 0.601 and from 0.604 to 0.652 by adding the highest maximum standardized uptake value to the parameter set of the Bajorin model and Apolo model, respectively. |
4 |
| 123. Tanaka H, Yoshida S, Komai Y, et al. Clinical Value of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Upper Tract Urothelial Carcinoma: Impact on Detection of Metastases and Patient Management. Urol Int. 96(1):65-72, 2016. |
Observational-Dx |
56 patients |
To determine the diagnostic accuracy of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting metastasis and its impact on patient management with upper tract urothelial carcinoma (UTUC). |
The sensitivity of PET/CT was significantly better than that of CT (85 vs. 50%, p = 0.0001). In the patient-based analysis, 22 patients were diagnosed as having metastases. The sensitivity/specificity/accuracy of PET/CT tended to be superior to those of CT, but these values were not significantly different (95, 91, and 93% vs. 82, 85, and 84%; p = 0.25, 0.50, and 0.063, respectively). The clinicians changed their assessments of disease extent and management plans in 18 (32%) and 11 (20%) patients, respectively, based on the PET/CT results. |
3 |
| 124. Takahashi N, Glockner JF, Hartman RP, et al. Gadolinium enhanced magnetic resonance urography for upper urinary tract malignancy. J Urol. 183(4):1330-65, 2010 Apr. |
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 |
| 125. Obuchi M, Ishigami K, Takahashi K, et al. Gadolinium-enhanced fat-suppressed T1-weighted imaging for staging ureteral carcinoma: correlation with histopathology. AJR Am J Roentgenol. 188(3):W256-61, 2007 Mar. |
Observational-Dx |
12 patients |
To retrospectively compare contrast-enhanced fat-suppressed T1-weighted images with histopathologic findings in ureteral carcinoma to develop accurate preoperative MR criteria for T staging. |
In the segments of ureters involved with tumors, three kinds of structures could be seen: first, an intensely enhancing rim, which corresponded to thickening of the ureteral wall due to marked proliferation of fibrous tissue with little or no invasion of cancer cells; second, moderately enhancing mass, which corresponded to cancer cells (both TCC and SCC); and, third, poorly or nonenhancing structures, which corresponded to necrotic tissue. |
3 |
| 126. Akita H, Jinzaki M, Kikuchi E, et al. Preoperative T categorization and prediction of histopathologic grading of urothelial carcinoma in renal pelvis using diffusion-weighted MRI. AJR Am J Roentgenol. 197(5):1130-6, 2011 Nov. |
Observational-Dx |
40 patients |
To evaluate the utility of diffusion-weighted MRI (DWI) for preoperative T categorization and prediction of the histopathologic grade of renal pelvic cancer. |
T2-weighted imaging plus DWI enabled a high detection rate (98%, 39/40) without significant differences. For the diagnosis of T3 or higher categories, the accuracies were relatively low in all three image sets (70% each for T2-weighted imaging plus DWI and T2-weighted imaging plus contrast-enhanced imaging and 58% for T2-weighted imaging alone, p > 0.05), with sensitivities of 58%, 65%, and 54%, respectively. For discriminating tumors with macroscopic renal invasion from those with microscopic renal invasion or less, T2-weighted imaging plus DWI (93%) was significantly more accurate than T2-weighted imaging alone (75%) (p = 0.016). The mean apparent diffusion coefficient of the high-grade tumors was significantly lower than that of the low-grade tumors (p < 0.01). |
2 |
| 127. 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 |
