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  • Bladder neck pTa HG Traditional Papillary F

    2020-08-12

    Bladder neck 1 30 pTa HG Traditional Papillary 21 F 69 Former Negative No NMIBC Multifocal 5 10–10–40–30–10 pTa LG Traditional Papillary 22 M 69 Former NA Yes MIBC Left side wall 1 50 pT2 HG Traditional Papillary 23 M 70 Yes Negative Yes NMIBC Trigone 1 24 pT1 HG Traditional Sessile
    F = female; HG = high grade; LG = low grade; M = male; MIBC = muscle-invasive bladder cancer; mUS = microultrasound; NMIBC = non-muscle-invasive bladder cancer; NA = not available; pTNM = pathological tumor-node-metastasis; TUR = transurethral resection.
    Please cite this article in press as: Saita A, et al. Assessing the Feasibility and Accuracy of High-resolution Microultrasound Imaging for Bladder Cancer Detection and Staging. Eur Urol (2019), https://doi.org/10.1016/j.eururo.2019.03.044
    Fig. 1 – (A) Micro-US and (B) histopathological view of the normal bladder 133-89-1 wall appearing as a three-layered structure consisting of the inner mucosa (hyperechoic), the detrusor muscle (medium homogeneous echogenicity), and the outer serosa (hyperechoic thin layer). US = ultrasound.
    Fig. 2 – (A) Micro-US and (B) histopathological view of non-muscle-invasive bladder cancer: the lesion is not disrupting the hyperechoic line representing the lamina propria. US = ultrasound.
    Fig. 3 – (A) Micro-US and (B) histopathological view (B) of muscle-invasive bladder cancer: the tumor is clearly extending into the muscular layer, showing a hyperechoic aspect at the 133-89-1 of the lesion associated with a “starry sky” pattern (blue arrows). US = ultrasound.
    Please cite this article in press as: Saita A, et al. Assessing the Feasibility and Accuracy of High-resolution Microultrasound Imaging for Bladder Cancer Detection and Staging. Eur Urol (2019), https://doi.org/10.1016/j.eururo.2019.03.044
    high-frequency mUS may become an alternative tool in the BC treatment decision-making process.
    For BC staging, CTU is generally performed. However, this imaging tool has its drawbacks, especially in the evaluation of tumor invasion into the muscularis propria [12]. To overcome these limitations, the use of MRI including functional sequences (mpMRI) has been suggested to be able to discriminate between NMIBC and MIBC [13]. This imaging technique could potentially improve BC diagnosis and staging, but it may also result in overstaging as tumor-associated fibrosis or inflammation can mimic the low signal intensity of the muscularis propria [14]. Thus, a VI-RADS, such as the Prostate Imaging Reporting and Data System (PI-RADS) for PCa, has been developed to help define and standardize the grade of BC invasion [5]. MRI and the VI-RADS may provide data about the extent of muscle invasion, exact location, and information to optimize the bladder-sparing trimodal therapy for MIBC for a more focused treatment and response evaluation [15]. However, the VI-RADS score still needs to be validated through the comparison of MRI descriptions with the histopathological results in different clinical situations. In addition, several potential drawbacks of MRI have to be considered, such as MRI is costly, there are multiple causes of artifacts, and image quality has to be excellent in order to get a correct interpretation of images by radiologists [16].
    Recently, the novel 29-MHz high-resolution mUS system has been developed, enabling about 300% higher resolution than conventional transrectal ultrasound systems, for prostate imaging [17,18]. Ghai et al. [17] developed the PCa risk identification system mUS (PRI-MUS), which could guide urologists to achieve accurate and reproducible results for PCa detection. With the PRI-MUS protocol, the authors achieved a mean accuracy of 0.60 0.02, which is comparable with those reported by several studies per-formed using the MRI-based PI-RADS score [19,20]. Recent-ly, Lughezzani et al. [8] confirmed that mUS could reliably exclude the presence of csPCa in the great majority of patients and that mUS is not inferior to MRI for the detection of csPCa in the peripheral zone of the prostate.
    We decided to test the use of mUS technology for BC staging. In our preliminary experience, we were able to describe the normal anatomy and suggest a tumor characterization that found a correlation with the respec-tive histopathological analysis in 90.5% of cases; 9.5% of cases were staged MIBC instead of NMIBC. The reason can be attributed mostly to the lack of expertise in the use of this technique in this specific setting and correlated with the learning curve. The main procedural limitation was that the probe shape was not designed for bladder visualization, which resulted in the failure to accurately stage two out of 23 (8.7%) patients.