Urology Department, CHU Bordeaux, 33000, Bordeaux, France.
Radiology Department, Institut Paoli-Calmettes, 13009, Marseille, France.
World J Urol. 2024 Mar 20;42(1):178. doi: 10.1007/s00345-024-04868-8.
The standard follow-up for non-muscle-invasive bladder cancer is based on cystoscopy. Unfortunately, post-instillation inflammatory changes can make the interpretation of this exam difficult, with lower specificity. This study aimed to evaluate the interest of bladder MRI in the follow-up of patients following intravesical instillation.
Data from patients who underwent cystoscopy and bladder MRI in a post-intravesical instillation setting between February 2020 and March 2023 were retrospectively collected. Primary endpoint was to evaluate and compare the diagnostic performance of cystoscopy and bladder MRI in the overall cohort (n = 67) using the pathologic results of TURB as a reference. The secondary endpoint was to analyze the diagnostic accuracy of cystoscopy and bladder MRI according to the appearance of the lesion on cystoscopy [flat (n = 40) or papillary (n = 27)].
The diagnostic performance of bladder MRI was better than that of cystoscopy, with a specificity of 47% (vs. 6%, p < 0.001), a negative predictive value of 88% (vs. 40%, p = 0.03), and a positive predictive value of 66% (vs. 51%, p < 0.001), whereas the sensitivity did not significantly differ between the two exams. In patients with doubtful cystoscopy and negative MRI findings, inflammatory changes were found on TURB in most cases (17/19). The superiority in MRI bladder performance prevailed for "flat lesions", while no significant difference was found for "papillary lesions".
In cases of doubtful cystoscopy after intravesical instillations, MRI appears to be relevant with good performance in differentiating post-therapeutic inflammatory changes from recurrent tumor lesions and could potentially allow avoiding unnecessary TURB.
非肌肉浸润性膀胱癌的标准随访基于膀胱镜检查。然而，膀胱镜检查后炎症反应会导致检查结果难以解读，特异性降低。本研究旨在评估膀胱 MRI 在膀胱内灌注治疗后的患者随访中的应用价值。
回顾性收集了 2020 年 2 月至 2023 年 3 月间在膀胱内灌注治疗后进行膀胱镜和膀胱 MRI 检查的患者数据。主要终点是使用 TURB 的病理结果作为参考，评估并比较膀胱镜和膀胱 MRI 在整体队列（n=67）中的诊断性能。次要终点是根据膀胱镜下病变的外观（平坦[n=40]或乳头状[n=27]）分析膀胱镜和膀胱 MRI 的诊断准确性。
与膀胱镜相比，膀胱 MRI 的诊断性能更好，特异性为 47%（6%，p<0.001），阴性预测值为 88%（40%，p=0.03），阳性预测值为 66%（51%，p<0.001），而两种检查的敏感性无显著差异。在膀胱镜检查结果可疑且 MRI 检查结果阴性的患者中，TURB 检查结果显示大多数为炎症改变（17/19）。MRI 在诊断膀胱病变方面的优势在“平坦病变”中更为明显，而在“乳头状病变”中则无显著差异。
在膀胱内灌注治疗后膀胱镜检查结果可疑的情况下，MRI 似乎具有良好的性能，能够区分治疗后炎症改变与复发性肿瘤病变，可能有助于避免不必要的 TURB。
