Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Building 10, Room 1-5940 W, Bethesda, MD, 20892, USA.
Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, USA.
Curr Urol Rep. 2019 Nov 28;20(12):82. doi: 10.1007/s11934-019-0948-7.
Local tumor staging is paramount in the evaluation and management of bladder cancer. While neoadjuvant chemotherapy (NAC) followed by radical cystectomy and urinary diversion remains the gold standard for management of muscle-invasive bladder cancer, bladder-sparing regimens involving systemic chemotherapy and pelvic radiotherapy remain a viable option for select patients. Moreover, pre-cystectomy identification of patients with a complete response to NAC may obviate the need for radical cystectomy, but accurate post-therapy staging can be difficult to achieve. Contemporary imaging techniques may provide additional benefit in local tumor staging beyond standard imaging and cystoscopic biopsy. Our purpose is to summarize the ability of different imaging modalities to accurately stage bladder cancer patients in the treatment-naïve and post-chemotherapy settings.
Contemporary investigations have been studying multiparametric magnetic resonance imaging (mp-MRI) in the evaluation of bladder cancer. Its recent incorporation into bladder cancer staging is mainly being assessed in treatment-naïve patients; however, different sequences are being studied to assess their accuracy after the introduction of chemotherapy and possibly radiation. Multiple recent studies incorporating cystoscopy and biopsy are proving to be less accurate than originally predicted. Imaging has generally had a very limited role in guiding therapy in localized bladder cancer, but with the incorporation of newer sequences and techniques, imaging is poised to become vital in decision-making strategies of this cancer. Reliable local tumor staging through improved imaging may help better select patients for bladder-sparing treatments while maintaining optimized oncologic outcomes and allow this paradigm to become more acceptable in the urologic oncology community.
局部肿瘤分期是膀胱癌评估和管理的关键。新辅助化疗（NAC）后行根治性膀胱切除术和尿流改道仍然是肌层浸润性膀胱癌的金标准治疗方法，但对于某些患者，包括全身化疗和盆腔放疗的膀胱保留方案仍是可行的选择。此外，在接受 NAC 治疗前识别对 NAC 完全缓解的患者，可能避免行根治性膀胱切除术，但准确的术后分期可能具有挑战性。与标准影像学和膀胱镜活检相比，当代影像学技术可能在局部肿瘤分期方面提供额外的获益。我们的目的是总结不同影像学方法在治疗前和化疗后准确分期膀胱癌患者的能力。
目前已有多项研究探讨了多参数磁共振成像（mp-MRI）在膀胱癌评估中的应用。其在膀胱癌分期中的应用主要在治疗前患者中进行评估；然而，正在研究不同的序列，以评估在引入化疗和（可能）放疗后的准确性。多项最新研究表明，将膀胱镜检查和活检相结合的方法的准确性不如最初预测的那么高。影像学在指导局限性膀胱癌治疗方面的作用一般非常有限，但随着新序列和技术的应用，影像学在该癌症的决策策略中可能变得至关重要。通过改进的影像学进行可靠的局部肿瘤分期，可能有助于更好地选择接受膀胱保留治疗的患者，同时保持优化的肿瘤学结果，并使这种治疗模式在泌尿外科肿瘤学界得到更广泛的接受。
