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Imaging Recommendations for Diagnosis, Staging, and Management of Bladder and Urethral Malignancies

CC BY 4.0 · Indian J Med Paediatr Oncol 2023; 44(02): 268-274

DOI: DOI: 10.1055/s-0042-1760315

Abstract

Bladder cancer (BCa) is a leading cause of cancer worldwide with high incidence and mortality across all ages. Early diagnosis and treatment can lead to significantly improved survival rate and overall prognosis. Smoking is the biggest contributing factor for the development of BCa. Urothelial carcinoma is the most common histological subtype. Commonly implemented imaging techniques include computed tomography urography (CTU) and multiparametric magnetic resonance imaging (mpMRI). CTU is the investigation of choice for muscle invasive bladder cancer (MIBC) and is best utilized for local assessment and staging of larger and higher staged tumors, that is, T3b and T4. mpMRI encompasses T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging. It can differentiate ≤T1 and ≥T2 tumors based on the Vesicle Imaging-Reporting and Data System (VI-RADS) assessment as well as differentiate Ta from T1 tumors, and is useful in post-therapy response assessment of BCa. Positron emission tomography/computed tomography is used in selected patients of MIBC for metastatic evaluation, particularly those with deranged renal function. A synoptic reporting template should be used to have standardization of data. Primary urethral cancer (UCa) is a rare and aggressive malignancy, accounting for less than 1% of all malignancies. MRI is the investigation of choice for UCa.



Publication History

Article published online:
04 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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Abstract

Bladder cancer (BCa) is a leading cause of cancer worldwide with high incidence and mortality across all ages. Early diagnosis and treatment can lead to significantly improved survival rate and overall prognosis. Smoking is the biggest contributing factor for the development of BCa. Urothelial carcinoma is the most common histological subtype. Commonly implemented imaging techniques include computed tomography urography (CTU) and multiparametric magnetic resonance imaging (mpMRI). CTU is the investigation of choice for muscle invasive bladder cancer (MIBC) and is best utilized for local assessment and staging of larger and higher staged tumors, that is, T3b and T4. mpMRI encompasses T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging. It can differentiate ≤T1 and ≥T2 tumors based on the Vesicle Imaging-Reporting and Data System (VI-RADS) assessment as well as differentiate Ta from T1 tumors, and is useful in post-therapy response assessment of BCa. Positron emission tomography/computed tomography is used in selected patients of MIBC for metastatic evaluation, particularly those with deranged renal function. A synoptic reporting template should be used to have standardization of data. Primary urethral cancer (UCa) is a rare and aggressive malignancy, accounting for less than 1% of all malignancies. MRI is the investigation of choice for UCa.


Introduction and Epidemiology

As per GLOBOCAN 2020, there were 573,278 new cases with a total of 212,536 number of deaths associated with bladder cancer (BCa) across all ages and both sexes in the year 2020.[1] BCa was ranked 10th in incidence and 13th in mortality among all cancers, and is estimated to be the 6th most commonly diagnosed cancer in men worldwide.[1] In India, it is ranked 17th in incidence and 19th in mortality, having varying incidence rates across different regions and populations.[2]

As per the SEER statistics (Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, US), the 5-year survival rate is as high as 90% for carcinoma in situ and 70% for localized disease, with a significant drop to 36% for regional and 5% for metastatic disease.[3] This indirectly reflects the success of early diagnosis and poor prognosis of metastatic disease. Improved understanding of the disease, superior imaging techniques for diagnosis, and advances in treatment have contributed to a significant decrease in the BCa-related mortality rates worldwide.[4]

A four times higher incidence rate has been observed in men than women.[5] The worldwide age-standardized incidence rate (per 100,000 person/years) is 9.5 for men and 2.4 for women.[5] Almost 90% of the newly diagnosed cases of BCa are seen in individuals of age 55 years or older with an average age of diagnosis of 73 years.[6] BCa is not typically hereditary; however, some cancer syndromes can predispose an individual to BCa, like Cowden syndrome and Lynch syndrome.[7] [8]


Risk Factors and Etiopathogenesis

Active and passive tobacco smoking has a strong relationship with BCa and is one of the greatest risk factors that is quantity and duration dependent. The relative risk for cancer-mortality from smoking is second only to lung cancer.[9] The attributable risk to smoking is similar between men and women.[5] [9] Exposure to aromatic amines, polycyclic aromatic hydrocarbons, and chlorinated hydrocarbons from dyes, paint, metal, rubber, or petroleum industries is another common preventable risk factor for BCa. Occupational exposures are responsible for approximately 18% of all BCa cases.[10] An environmental factor most commonly implicated in BCa is arsenic consumption, typically through ingestion of contaminated water.[11] Increased rates of secondary BCa have also been reported following use of external-beam radiotherapy (EBRT) for gynecological malignancies; however, lower rates have been observed with use of intensity-modulated radiotherapy for prostate cancer.[12] [13] A tropical protozoan schistosomiasis, through generation of N-nitroso carcinogenic compound,[14] and chronic bladder irritation from indwelling catheters or vesicle stones are responsible for squamous cell carcinoma (SCC) of the bladder.

Urothelial carcinoma (UC), also known as transitional cell carcinoma, is the most common subtype of BCa, seen in 90% of cases.[15] At presentation, approximately 2

  • References

  1.  Accessed December 12, 2022, at: https://gco.iarc.fr/today/data/factsheets/cancers/30-Bladder-fact-sheet.pdf
  2.  Three-Year Report of Population Based Cancer Registries 2012–2014. 2016. Incidence, Distribution, Trends in Incidence Rates and Projections of Burden of Cancer (Report of 27 PBCRs in India). Accessed December 12, 2022, at: http://www.ncdirindia.org/NCRP/all_ncrp_reports/pbcr_report_2012_2014/all_content/pdf_printed_version/preliminary_pages_printed.pdf
  3.  SEER*Explorer. [(accessed on 13 January 2020)]; Accessed December 12, 2022, at: https://seer.cancer.gov/explorer/
  4.  Al-Husseini MJ, Kunbaz A, Saad AM. et al. Trends in the incidence and mortality of transitional cell carcinoma of the bladder for the last four decades in the USA: a SEER-based analysis. BMC Cancer 2019; 19 (01) 46
  5.  Saginala K, Barsouk A, Aluru JS, Rawla P, Padala SA, Barsouk A. Epidemiology of bladder cancer. Med Sci (Basel) 2020; 8 (01) 15
  6.  Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69 (01) 7-34
  7.  Riegert-Johnson DL, Gleeson FC, Roberts M. et al. Cancer and Lhermitte-Duclos disease are common in Cowden syndrome patients. Hered Cancer Clin Pract 2010; 8 (01) 6 DOI: 10.1186/1897-4287-8-6.
  8.  van der Post RS, Kiemeney LA, Ligtenberg MJL. et al. Risk of urothelial bladder cancer in Lynch syndrome is increased, in particular among MSH2 mutation carriers. J Med Genet 2010; 47 (07) 464-470
  9.  Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA 2011; 306 (07) 737-745
  10.  Chen HI, Liou SH, Loh CH, Uang SN, Yu YC, Shih TS. Bladder cancer screening and monitoring of 4,4′-methylenebis(2-chloroaniline) exposure among workers in Taiwan. Urology 2005; 66 (02) 305-310
  11.  Marshall G, Ferreccio C, Yuan Y. et al. Fifty-year study of lung and bladder cancer mortality in Chile related to arsenic in drinking water. J Natl Cancer Inst 2007; 99 (12) 920-928
  12.  Chrouser K, Leibovich B, Bergstralh E, Zincke H, Blute M. Bladder cancer risk following primary and adjuvant external beam radiation for prostate cancer. J Urol 2005; 174 (01) 107-110 , discussion 110–111
  13.  Zelefsky MJ, Housman DM, Pei X. et al. Incidence of secondary cancer development after high-dose intensity-modulated radiotherapy and image-guided brachytherapy for the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys 2012; 83 (03) 953-959
  14.  Verma S, Rajesh A, Prasad SR. et al. Urinary bladder cancer: role of MR imaging. Radiographics 2012; 32 (02) 371-387
  15.  Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO Classification of tumors of the urinary system and male genital organs-part B. Prostate and Bladder Tumors. Eur. Urol. 2016; 70: 106-119
  16.  Lee CH, Tan CH, Faria SC, Kundra V. Role of imaging in the local staging of urothelial carcinoma of the bladder. AJR Am J Roentgenol 2017; 208 (06) 1193-1205
  17.  Chalasani V, Chin JL, Izawa JI. Histologic variants of urothelial bladder cancer and nonurothelial histology in bladder cancer. Can Urol Assoc J 2009; 3 (6, Suppl 4): S193-S198
  18.  Flaig TW, Spiess PE, Agarwal N. et al. Bladder cancer, Version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2020; 18 (03) 329-354
  19.  Sun M, Trinh Q-D. Diagnosis and staging of bladder cancer. Hematol Oncol Clin North Am 2015; 29 (02) 205-218 , vii
  20.  Wolfman DJ, Marko J, Nikolaidis P. et al. Expert panel on urological imaging. ACR Appropriateness Criteria® Hematuria. J Am Coll Radiol 2020; 17 (5S): S138-S147
  21.  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 (NY) 2018; 43 (03) 663-671
  22.  Mirmomen SM, Shinagare AB, Williams KE, Silverman SG, Malayeri AA. Preoperative imaging for locoregional staging of bladder cancer. Abdom Radiol (NY) 2019; 44 (12) 3843-3857
  23.  Galgano SJ, Porter KK, Burgan C, Rais-Bahrami S. The role of imaging in bladder cancer diagnosis and staging. Diagnostics (Basel) 2020; 10 (09) 703
  24.  Moon WK, Kim SH, Cho JM, Han MC. Calcified bladder tumors. CT features. Acta Radiol 1992; 33 (05) 440-443
  25.  Mossanen M, Chang SL, Kimm S, Sonpavde GP, Kibel AS. Current staging strategies for muscle-invasive bladder cancer and upper tract urothelial cell carcinoma. Urol Clin North Am 2018; 45 (02) 143-154
  26.  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 2017; 15 (03) e387-e395
  27.  Cornelissen SWE, Veenboer PW, Wessels FJ, Meijer RP. Diagnostic accuracy of multiparametric MRI for local staging of bladder cancer: a systematic review and meta-analysis. Urology 2020; 145: 22-29
  28.  Gandhi N, Krishna S, Booth CM. et al. Diagnostic accuracy of magnetic resonance imaging for tumour staging of bladder cancer: systematic review and meta-analysis. BJU Int 2018; 122 (05) 744-753
  29.  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). Eur Urol 2018; 74 (03) 294-306
  30.  Caglic I, Panebianco V, Vargas HA. et al. MRI of bladder cancer: local and nodal staging. J Magn Reson Imaging 2020; 52 (03) 649-667
  31.  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 (01) 112-121
  32.  Bryan RT, Liu W, Pirrie SJ. et al. Comparing an imaging-guided pathway with the standard pathway for staging muscle-invasive bladder cancer: preliminary data from the BladderPath Study. Eur Urol 2021; 80 (01) 12-15
  33.  Yuan L, Li D, Mu D. et al. Combined T2 SPAIR, dynamic enhancement and DW imaging reliably detect T staging and grading of bladder cancer with 3.0T MRI. Front Oncol 2020; 10: 582532
  34.  Necchi A, Bandini M, Calareso G. et al. Multiparametric magnetic resonance imaging as a noninvasive assessment of tumor response to neoadjuvant pembrolizumab in muscle-invasive bladder cancer: preliminary findings from the PURE-01 study. Eur Urol 2020; 77 (05) 636-643
  35.  Bidnur S, Savdie R, Black PC. Inhibiting immune checkpoints for the treatment of bladder cancer. Bladder Cancer 2016; 2 (01) 15-25
  36.  van der Pol CB, Sahni VA, Eberhardt SC. et al; Expert Panel on Urologic Imaging. ACR appropriateness criteria® pretreatment staging of muscle-invasive bladder cancer. J Am Coll Radiol 2018; 15 ( 5S): S150-S159
  37.  Witjes JA, Babjuk M, Bellmunt J. et al. EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-An International Collaborative Multistakeholder Effort: Under the Auspices of the EAU-ESMO Guidelines Committees. Eur Urol 2020; 77 (02) 223-250
  38.  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 (09) 1229-1237
  39.  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 2019; 29 (08) 4286-4293
  40.  Chen R, Zhou X, Liu J, Huang G. Relationship between the expression of PD-1/PD-L1 and 18F-FDG uptake in bladder cancer. Eur J Nucl Med Mol Imaging 2019; 46 (04) 848-854
  41.  van de Putte EEF, Vegt E, Mertens LS. et al. FDG-PET/CT for response evaluation of invasive bladder cancer following neoadjuvant chemotherapy. Int Urol Nephrol 2017; 49 (09) 1585-1591
  42.  Zattoni F, Incerti E, Colicchia M. et al. Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas: a retrospective, multicenter study. Abdom Radiol (NY) 2018; 43 (09) 2391-2399
  43.  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 2017; 42 (01) e8-e15
  44.  Kim S-J, Koo PJ, Pak K, Kim I-J, Kim K. Diagnostic accuracy of C-11 choline and C-11 acetate for lymph node staging in patients with bladder cancer: a systematic review and meta-analysis. World J Urol 2018; 36 (03) 331-340
  45.  Loffroy R, Pottecher P, Cherblanc V. et al. Current role of transcatheter arterial embolization for bladder and prostate hemorrhage. Diagn Interv Imaging 2014; 95 (11) 1027-1034
  46.  Liu S, Zhang L, Zou L, Wen H, Ding Q, Jiang H. The feasibility and safety of cryoablation as an adjuvant therapy with transurethral resection of bladder tumor: a pilot study. Cryobiology 2016; 73 (02) 257-260
  47.  Liang Z, Fei Y, Lizhi N. et al. Percutaneous cryotherapy for metastatic bladder cancer: experience with 23 patients. Cryobiology 2014; 68 (01) 79-83
  48.  Barchetti G, Simone G, Ceravolo I. et al. Multiparametric MRI of the bladder: inter-observer agreement and accuracy with the Vesical Imaging-Reporting and Data System (VI-RADS) at a single reference center. Eur Radiol 2019; 29 (10) 5498-5506
  49.  Ueno Y, Takeuchi M, Tamada T. et al. Diagnostic accuracy and interobserver agreement for the Vesical Imaging-Reporting and Data System for muscle-invasive bladder cancer: a multireader validation study. Eur Urol 2019; 76 (01) 54-56
  50.  Del Giudice F, Barchetti G, De Berardinis E. et al. Prospective Assessment of Vesical Imaging Reporting and Data System (VI-RADS) and Its Clinical Impact on the Management of High-risk Non-muscle-invasive Bladder Cancer Patients Candidate for Repeated Transurethral Resection. Eur Urol 2020; 77 (01) 101-109
  51.  Panebianco V, De Berardinis E, Barchetti G. et al. An evaluation of morphological and functional multi-parametric MRI sequences in classifying non-muscle and muscle invasive bladder cancer. Eur Radiol 2017; 27 (09) 3759-3766
  52.  Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Diagnostic performance of MRI for prediction of muscle-invasiveness of bladder cancer: a systematic review and meta-analysis. Eur J Radiol 2017; 95: 46-55
  53.  Boorjian SA, Kim SP, Weight CJ, Cheville JC, Thapa P, Frank I. Risk factors and outcomes of urethral recurrence following radical cystectomy. Eur Urol 2011; 60 (06) 1266-1272
  54.  Gatta G, van der Zwan JM, Casali PG. et al; RARECARE working group. Rare cancers are not so rare: the rare cancer burden in Europe. Eur J Cancer 2011; 47 (17) 2493-2511
  55.  Swartz MA, Porter MP, Lin DW, Weiss NS. Incidence of primary urethral carcinoma in the United States. Urology 2006; 68 (06) 1164-1168
  56.  Chaudhari VV, Patel MK, Douek M, Raman SS. MR imaging and US of female urethral and periurethral disease. Radiographics 2010; 30 (07) 1857-1874
  57.  Kawashima A, Sandler CM, Wasserman NF, LeRoy AJ, King Jr BF, Goldman SM. Imaging of urethral disease: a pictorial review. Radiographics 2004; 24 (Suppl. 01) S195-S216