Imaging bladder cancer

Cowan, Nigel C.; Crew, Jeremy

doi:10.1097/mou.0b013e32833cbcb9

Cited by 35 publications

(15 citation statements)

References 44 publications

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“…The principal purpose of CT urography is assessment of the UUT, and CT protocols are designed to optimise UUT opacification and hence maximise diagnostic accuracy for UUT disease. In addition to diagnosing UUT‐UCC [36], CT urography can also be used to diagnose bladder cancer [10,11,37]. A secondary additional role is provision of a non‐invasive method of assessing bladder abnormalities [10–12].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

et al. 2011

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What ' s known on the subject? and What does the study add?Haematuria clinics with same day imaging and fl exible cystoscopy are an effi cient way for investigating patients with haematuria. The principal role of haematuria clinics with reference to bladder cancer is to determine which patients are ' normal ' and may be discharged, and which patients are abnormal and should undergo rigid cystoscopy. It is well recognised that CT urography offers a thorough evaluation of the upper urinary tract for stones, renal masses and urothelial neoplasms but the role of CT urography for diagnosing bladder cancer is less certain. The aim of the present study was to evaluate the diagnostic accuracy of CT urography in patients with visible haematuria aged > 40 years and to determine if CT urography has a role for diagnosing bladder cancer.This study shows that the optimum diagnostic strategy for investigating patients with visible haematuria aged > 40 years with infection excluded is a combined strategy using CT urography and fl exible cystoscopy. Patients positive for bladder cancer on CT urography should be referred directly for rigid cystoscopy and so avoid fl exible cystoscopy. The number of fl exible cystoscopies required therefore may be reduced by 17%. The present study also shows that the diagnostic accuracy of voided urine cytology is too low to justify its continuing use in a haematuria clinic using CT urography and fl exible cystoscopy. OBJECTIVES• To evaluate and compare the diagnostic accuracy of computed tomography (CT) urography with fl exible cystoscopy and voided urine cytology for diagnosing bladder cancer.• To evaluate diagnostic strategies using CT urography as: (i) an additional test or (ii) a replacement test or (iii) a triage test for diagnosing bladder cancer in patients referred to a hospital haematuria rapid diagnosis clinic. PATIENTS AND METHODS• The clinical cohort consisted of a consecutive series of 778 patients referred to a hospital haematuria rapid diagnosis clinic from 1 March 2004 to 17 December 2007. Criteria for referral were at least one episode of macroscopic haematuria, age > 40 years and urinary tract infection excluded. Of the 778 patients, there were 747 with technically adequate CT urography and fl exible cystoscopy examinations for analysis.• On the same day, patients underwent examination by a clinical nurse specialist followed by voided urine cytology, CT urography and fl exible cystoscopy. Voided urine cytology was scored using a 5-point system. CT urography was reported immediately by a uroradiologist and fl exible cystoscopy performed by a urologist. Both examinations were scored using a 3-point system: 1, normal; 2, equivocal; and 3, positive for bladder cancer.• The reference standard consisted of review of the hospital imaging and histopathology databases in December 2009 for all patients and reports from the medical notes for those referred for rigid cystoscopy. Follow-up was for 21 -66 months. RESULTS• The prevalence of bladder cancer in the clinical cohort was 20% (156/77...

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Section: Introductionmentioning

confidence: 99%

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

et al. 2011

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“…Eine weitere Option stellt das Ferumoxtran-10-enhanced MRT dar, welches eine signifikante Verbesserung der radiologischen Darstellung von Lymphknotenmetastasen, sowie des negativen prädiktiven Wert aufweist [24,25]. Diese neuartigen bildgebenden Verfahren benötigen weitere prospektive Untersuchungen, bisher wird als präoperative Staging die CT-Untersuchung empfohlen [26].…”

Section: Präoperative Evaluierung Des Lymphknotenstatusunclassified

Die Wertigkeit der Lymphadenektomie beim muskelinvasiven Urothelkarzinom der Harnblase - Ein Überblick über die aktuelle Datenlage

Sh¹,

Huber²,

Gakis³

et al. 2011

Aktuel Urol

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“…CT urography is particularly helpful beyond stage T3b, i.e., involvement of the perivesical fat and surrounding organs and in assessing the ureters and renal pelvis [28]. Sensitivity of CT imaging for diagnosing perivesical invasion is less compared to MRI (89 vs. 100%), but its specificity is greater (95 vs. 73%) [29].…”

Section: Ctmentioning

confidence: 99%

“…Since MRI is very sensitive, even mild inflammation around the cancerous region can mimic perivesical invasion. This results in over staging of these tumors [28].…”

Section: Mrimentioning

confidence: 99%

Current Concepts in the Management of Muscle Invasive Bladder Cancer

Krishna

Konety

2016

Indian J Surg Oncol

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Bladder cancer is the ninth most common cancer in the world. Twenty to twenty-five percent of all newly diagnosed bladder cancers are muscle invasive in nature, and further, 20-25% of patients who are diagnosed with high-risk nonmuscle invasive disease will eventually progress to muscle invasive disease in due course of time irrespective of adjuvant intravesical therapies. Availability of newer imaging modalities improves appropriate identification of patients with muscle invasive disease. Radical cystectomy remains the mainstay of treatment for management of muscle invasive disease. Availability of neoadjuvant chemotherapy has improved overall survival. Risk stratification systems are now in consideration to identify patients who benefit maximally from neoadjuvant chemotherapy. Urinary diversion is a major cause of morbidity in these patients, and several strategies are being employed to reduce morbidity. In this article, we review available literature on various aspects of management of muscle invasive disease. Histologically, over 90% of bladder tumors are transitional cell carcinomas. The other subtypes, such as squamous cell and adenocarcinoma, are uncommon and account for 5 and <2%, respectively. Bladder cancer is a heterogeneous disease with a variable natural progression. Urothelial carcinomas can have a component of Bvariant histology^such as squamous differentiation, micropapillary, or adenocarcinoma. Micropapillary variant of urothelial carcinoma is associated with worse prognosis than pure urothelial carcinoma. Around 70% of the patients present with tumors that are superficial and have a tendency to recur. The remaining 30% present with muscle invasive tumors [4]. PathologyLow-grade tumors represent 50-60% of the cases. Majority of the tumors are stage Ta, i.e., confined to the urothelium. These tumors tend to recur and generally require repeated transurethral resection (TURBT) and surveillance cystoscopies [5].High-grade (HG) lesions account for 20-25% of all new cases. These lesions can either be sessile or papillary lesions. These tumors have a tendency to invade into the bladder wall if left untreated, especially in the presence of carcinoma in situ (CIS). Despite treatment in the form TURBT and chemotherapy, more than 20% of the patients with high-grade lesions progress to muscle invasive bladder cancer (MIBC) [6,7]. This has led to a lot of controversy regarding aggressive treatment in the form of early radical cystectomy vs. TURBT along with intravesical therapy, particularly in patients with HG

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Imaging bladder cancer

Cited by 35 publications

References 44 publications

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

Die Wertigkeit der Lymphadenektomie beim muskelinvasiven Urothelkarzinom der Harnblase - Ein Überblick über die aktuelle Datenlage

Current Concepts in the Management of Muscle Invasive Bladder Cancer

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