Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK; Action Bladder Cancer, UK.
Cancer Research UK Clinical Trials Unit, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK.
Eur Urol. 2021 Jul;80(1):12-15. doi: 10.1016/j.eururo.2021.02.021. Epub 2021 Feb 27.
Transurethral resection of bladder tumour (TURBT) is central to the diagnosis of muscle-invasive bladder cancer (MIBC). With the oncological safety of TURBT unknown, staging inaccuracies commonplace, and correct treatment of MIBC potentially delayed, multiparametric magnetic resonance imaging (mpMRI) may offer rapid, accurate, and noninvasive diagnosis of MIBC. BladderPath is a randomised trial comparing risk-stratified (5-point Likert scale) image-directed care with TURBT for patients with newly diagnosed BC. To date, we have screened 279 patients and randomised 113. Here we report on the first 100 participants to complete staging: 48 in pathway 1 (TURBT) and 52 in pathway 2 (mpMRI for possible MIBC, Likert 3-5). Fifty of 52 participants designated Likert 1-2 (probable NMIBC) from both pathways were confirmed as having NMIBC (96%). Ten of 11 cases diagnosed as NMIBC by mpMRI have been pathologically confirmed as NMIBC, and 10/15 cases diagnosed as MIBC by mpMRI have been treated as MIBC (5 participants underwent TURBT). The specificity of mpMRI for identification of MIBC remains a limitation. These initial experiences indicate that it is feasible to direct possible MIBC patients to mpMRI for staging instead of TURBT. Furthermore, a 5-point Likert scale accurately identifies patients with low risk of MIBC (Likert 1-2), and flexible cystoscopy biopsies appear sufficient for diagnosing BC. PATIENT SUMMARY: We are conducting a clinical trial to assess whether some bladder tumour surgery can be replaced by magnetic resonance imaging scans to determine the stage of the cancer in patients whose tumours appear to be invasive. Our early data suggest that this approach is feasible. The data also show that using a visual score ('Likert scale') can help to identify bladder tumours that are very unlikely to be invasive, and that taking a biopsy in the outpatient clinic when first inspecting the bladder via a camera (diagnostic flexible cystoscopy) is useful for confirming bladder cancer.
经尿道膀胱肿瘤切除术（TURBT）是诊断肌层浸润性膀胱癌（MIBC）的核心手段。由于 TURBT 的肿瘤安全性尚不清楚，分期不准确的情况很常见，且 MIBC 的正确治疗可能被延误，多参数磁共振成像（mpMRI）可能为 MIBC 提供快速、准确和无创的诊断。BladderPath 是一项随机试验，比较了风险分层（5 分李克特量表）的图像指导护理与 TURBT 用于新诊断的 BC 患者。迄今为止，我们已经筛查了 279 名患者，并随机分配了 113 名。在此，我们报告了前 100 名完成分期的参与者：48 名在路径 1（TURBT），52 名在路径 2（mpMRI 用于可能的 MIBC，李克特 3-5）。两条路径中被指定为李克特 1-2（可能的非肌层浸润性膀胱癌）的 52 名参与者中的 50 名被证实患有非肌层浸润性膀胱癌（96%）。通过 mpMRI 诊断为非肌层浸润性膀胱癌的 11 例中有 10 例得到了病理证实，通过 mpMRI 诊断为肌层浸润性膀胱癌的 15 例中有 10 例被作为肌层浸润性膀胱癌进行治疗（5 例接受了 TURBT）。mpMRI 对 MIBC 的识别特异性仍然是一个限制。这些初步经验表明，将可能患有 MIBC 的患者引导至 mpMRI 进行分期而不是 TURBT 是可行的。此外，5 分李克特量表准确地识别出 MIBC 风险较低的患者（李克特 1-2），并且门诊膀胱镜活检似乎足以诊断膀胱癌。
我们正在进行一项临床试验，以评估是否可以用磁共振成像扫描代替一些膀胱癌手术，以确定肿瘤表现为侵袭性的患者的癌症分期。我们的早期数据表明，这种方法是可行的。这些数据还表明，使用视觉评分（“李克特量表”）可以帮助识别不太可能发生侵袭性的膀胱癌，并且在首次通过摄像头（诊断性软性膀胱镜检查）检查膀胱时，在门诊进行活检对于确认膀胱癌是有用的。
