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Ceachi B, Cioplea M, Mustatea P, Gerald Dcruz J, Zurac S, Cauni V, Popp C, Mogodici C, Sticlaru L, Cioroianu A, Busca M, Stefan O, Tudor I, Dumitru C, Vilaia A, Oprisan A, Bastian A, Nichita L. A New Method of Artificial-Intelligence-Based Automatic Identification of Lymphovascular Invasion in Urothelial Carcinomas. Diagnostics (Basel) 2024; 14:432. [PMID: 38396472 PMCID: PMC10888137 DOI: 10.3390/diagnostics14040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The presence of lymphovascular invasion (LVI) in urothelial carcinoma (UC) is a poor prognostic finding. This is difficult to identify on routine hematoxylin-eosin (H&E)-stained slides, but considering the costs and time required for examination, immunohistochemical stains for the endothelium are not the recommended diagnostic protocol. We developed an AI-based automated method for LVI identification on H&E-stained slides. We selected two separate groups of UC patients with transurethral resection specimens. Group A had 105 patients (100 with UC; 5 with cystitis); group B had 55 patients (all with high-grade UC; D2-40 and CD34 immunohistochemical stains performed on each block). All the group A slides and 52 H&E cases from group B showing LVI using immunohistochemistry were scanned using an Aperio GT450 automatic scanner. We performed a pixel-per-pixel semantic segmentation of selected areas, and we trained InternImage to identify several classes. The DiceCoefficient and Intersection-over-Union scores for LVI detection using our method were 0.77 and 0.52, respectively. The pathologists' H&E-based evaluation in group B revealed 89.65% specificity, 42.30% sensitivity, 67.27% accuracy, and an F1 score of 0.55, which is much lower than the algorithm's DCC of 0.77. Our model outlines LVI on H&E-stained-slides more effectively than human examiners; thus, it proves a valuable tool for pathologists.
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Affiliation(s)
- Bogdan Ceachi
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Faculty of Automatic Control and Computer Science, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independenţei, Sector 6, 060042 Bucharest, Romania
| | - Mirela Cioplea
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Petronel Mustatea
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania
| | - Julian Gerald Dcruz
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Sabina Zurac
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
| | - Victor Cauni
- Department of Urology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania
| | - Cristiana Popp
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Cristian Mogodici
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Liana Sticlaru
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Alexandra Cioroianu
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
| | - Mihai Busca
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Oana Stefan
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
| | - Irina Tudor
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
| | - Carmen Dumitru
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
| | - Alexandra Vilaia
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
| | - Alexandra Oprisan
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
- Department of Neurology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania
| | - Alexandra Bastian
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
| | - Luciana Nichita
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
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Carlsen B, Klingen TA, Andreassen BK, Haug ES. Tumor cell invasion in blood vessels assessed by immunohistochemistry is related to decreased survival in patients with bladder cancer treated with radical cystectomy. Diagn Pathol 2021; 16:109. [PMID: 34809660 PMCID: PMC8609845 DOI: 10.1186/s13000-021-01171-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Lymphovascular invasion (VI) is an established prognostic marker for many cancers including bladder cancer. There is a paucity of data regarding whether the prognostic significance of lymphatic invasion (LVI) differs from blood vessel invasion (BVI). The aim was to examine LVI and BVI separately using immunohistochemistry (IHC), and investigate their associations with clinicopathological characteristics and prognosis. A secondary aim was to compare the use of IHC with assessing VI on standard HAS (hematoxylin-azophloxine-saffron) sections without IHC. Methods A retrospective, population –based series of 292 invasive bladder cancers treated with radical cystectomy (RC) with curative intent at Vestfold Hospital Trust, Norway were reviewed. Traditional histopathological markers and VI based on HAS sections were recorded. Dual staining using D2–40/CD31 antibodies was performed on one selected tumor block for each case. Results The frequency of LVI and BVI was 32 and 28%, respectively. BVI was associated with features such as higher pathological stages, positive regional lymph nodes, bladder neck involvement and metastatic disease whereas LVI showed weaker or no associations. Both BVI and LVI independently predicted regional lymph node metastases, LVI being the slightly stronger factor. BVI, not LVI predicted higher pathological stages. BVI showed reduced recurrence free (RFS) and disease specific (DSS) survival in uni-and multivariable analyses, whereas LVI did not. On HAS sections, VI was found in 31% of the cases. By IHC, 51% were positive, corresponding to a 64% increased sensitivity in detecting VI. VI assessed without IHC was significantly associated with RFS and DSS in univariable but not multivariable analysis. Conclusions Our findings indicate that BVI is strongly associated with more aggressive tumor features. BVI was an independent prognostic factor in contrast to LVI. Furthermore, IHC increases VI sensitivity compared to HAS. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-021-01171-7.
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Affiliation(s)
- Birgitte Carlsen
- Department of Pathology, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, N-3103, Tonsberg, Norway.
| | - Tor Audun Klingen
- Department of Pathology, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, N-3103, Tonsberg, Norway
| | | | - Erik Skaaheim Haug
- Department of Urology, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, N-3103, Tonsberg, Norway
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Gakis G, Karl A, Bertz S, Burger M, Fritsche HM, Hartmann A, Jokisch F, Kempkensteffen C, Miller K, Mundhenk J, Schneevoigt BS, Schubert T, Schwentner C, Wullich B, Stenzl A. Transurethral en bloc submucosal hydrodissection vs conventional resection for resection of non-muscle-invasive bladder cancer (HYBRIDBLUE): a randomised, multicentre trial. BJU Int 2020; 126:509-519. [PMID: 32578332 DOI: 10.1111/bju.15150] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether transurethral en bloc submucosal hydrodissection of bladder tumours (TUEB) improves the quality of the resection compared to conventional transurethral resection of bladder tumour (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS A randomised, multicentre trial (HYBRIDBLUE) was conducted with a superiority design. Six German academic centres participated between September 2012 and August 2015. Based on literature analysis, a sample size for accurate histopathological assessment concerning muscle invasion was assumed to be feasible in 50% (P0 = 0.5) of TURBT and 80% of TUEB cases. After pre-screening of a total of 305 patients, participants were allocated to two study arms: Group I: hexaminolevulinate (HAL)-guided TUEB; Group II: conventional HAL-guided TURBT. The primary endpoint was the proportion of specimens that could be reliably evaluated pathologically concerning muscle invasiveness. Secondary endpoints included rates of histopathological completeness of the resection, muscularis propria content, recurrence, and complication rates. RESULTS A total of 115 patients (TUEB 56; TURBT 59) were eligible for final analysis. Adequate histopathological assessment, which included muscularis propria content and tumour margins (R0 vs R1), was present in 48/56 (86%) TUEB patients compared to 37/59 (63%; P = 0.006) in the TURBT group. R0 was confirmed in 30/56 TUEB patients (57%) and five of 59 TURBT patients (9%; P < 0.001). No complications of Grade ≥III were observed in both arms. At 3 and 12 months, three and 19 patients recurred in the TUEB group vs seven and 11 patients in the TURBT group, respectively (P = 0.33 and P = 0.08). CONCLUSIONS In this randomised study, TUEB was shown to be clinically safe regarding perioperative endpoints. An adequate histopathological assessment concerning muscle invasion was significantly better assessable in the TUEB arm compared to standard TURBT. This finding indicates the clinical potential for reducing the rate of early re-resections. Yet, a larger study with recurrence-free survival as the primary endpoint is needed to assess the oncological efficacy between both techniques.
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Affiliation(s)
- Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany.,Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Alexander Karl
- Department of Urology, University Hospital of Munich-Grosshadern, Munich, Germany
| | - Simone Bertz
- Department of Pathology, University Hospital of Erlangen-Nürnberg, Erlangen, Germany
| | - Maximillian Burger
- Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Regensburg, Germany
| | - Hans-Martin Fritsche
- Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Department of Pathology, University Hospital of Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich Jokisch
- Department of Urology, University Hospital of Munich-Grosshadern, Munich, Germany
| | | | - Kurt Miller
- Department of Urology, Charite, University Hospital of Berlin, Berlin, Germany
| | - Jens Mundhenk
- Department of Urology, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | | | - Tina Schubert
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany.,Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | | | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
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Kramer MW, Gakis G. [Immuno-oncological therapeutic options in high-risk non-muscle invasive bladder cancer]. Urologe A 2020; 59:784-789. [PMID: 32468091 DOI: 10.1007/s00120-020-01233-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High-risk nonmuscle invasive bladder cancer (HR NMIBC) is an immunological malignancy. The standard therapy for HR NMIBC is based on transurethral bladder tumor resection with adjuvant Bacillus Calmette Guérin (BCG) instillation therapy. To prevent progression in case of BCG-refractory disease, early radical cystectomy is considered the therapy of choice according to the German S3 guidelines. With the advent of checkpoint inhibitors for the treatment of metastatic urological malignancies, a novel option for bladder preservation has been introduced for the treatment of HR NMIBC. The currently available data do not allow a meaningful conclusion on the long-term efficacy of PD-(L)1 (programmed cell death [ligand] 1) inhibitors due to the relatively short duration of oncological follow-up. Yet, it can be expected that checkpoint inhibitors will change the treatment algorithm of HR NMIBC in the next few years. Promising studies have been initiated to test the combination of local and systemic immunomodulation in terms of response and toxicity.
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Affiliation(s)
- M W Kramer
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - G Gakis
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
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The Role and Importance of Timely Radical Cystectomy for High-Risk Non-muscle-Invasive Bladder Cancer. Cancer Treat Res 2019; 175:193-214. [PMID: 30168123 DOI: 10.1007/978-3-319-93339-9_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Non-muscle-invasive bladder cancer accounts for the majority of incident bladder cancers but is a heterogeneous disease with variation in clinical presentation, course, and outcomes. Risk stratification techniques have attempted to identify those at highest risk of cancer recurrence and progression to help personalize and individualize treatment options. Radical cystectomy during the optimal window of curability could improve cancer outcomes; however, identifying the disease and patient characteristics as well as the correct timing to intervene remains difficult. We review the natural history of non-muscle-invasive bladder cancer, discuss different risk-stratification techniques and how they can help identify those most likely to benefit from radical treatment, and examine the evidence supporting the benefit of timely cystectomy.
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Mari A, Kimura S, Foerster B, Abufaraj M, D'Andrea D, Hassler M, Minervini A, Rouprêt M, Babjuk M, Shariat SF. A systematic review and meta-analysis of the impact of lymphovascular invasion in bladder cancer transurethral resection specimens. BJU Int 2018; 123:11-21. [PMID: 29807387 PMCID: PMC7379926 DOI: 10.1111/bju.14417] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of the present review was to assess the prognostic impact of lymphovascular invasion (LVI) in transurethral resection (TUR) of bladder cancer (BCa) specimens on clinical outcomes. A systematic review and meta-analysis of the available literature from the past 10 years was performed using MEDLINE, EMBASE and Cochrane library in August 2017. The protocol for this systematic review was registered on PROSPERO (Central Registration Depository: CRD42018084876) and is available in full on the University of York website. Overall, 33 studies (including 6194 patients) evaluating the presence of LVI at TUR were retrieved. LVI was detected in 17.3% of TUR specimens. In 19 studies, including 2941 patients with ≤cT1 stage only, LVI was detected in 15% of specimens. In patients with ≤cT1 stage, LVI at TUR of the bladder tumour (TURBT) was a significant prognostic factor for disease recurrence (pooled hazard ratio [HR] 1.97, 95% CI: 1.47-2.62) and progression (pooled HR 2.95, 95% CI: 2.11-4.13), without heterogeneity (I2 = 0.0%, P = 0.84 and I2 = 0.0%, P = 0.93, respectively). For patients with cT1-2 disease, LVI was significantly associated with upstaging at time of radical cystectomy (pooled odds ratio 2.39, 95% CI: 1.45-3.96), with heterogeneity among studies (I2 = 53.6%, P = 0.044). LVI at TURBT is a robust prognostic factor of disease recurrence and progression in non-muscle invasive BCa. Furthermore, LVI has a strong impact on upstaging in patients with organ-confined disease. The assessment of LVI should be standardized, reported, and considered for inclusion in the TNM classification system, helping clinicians in decision-making and patient counselling.
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Affiliation(s)
- Andrea Mari
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Shoji Kimura
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Beat Foerster
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Special Surgery, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Melanie Hassler
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Morgan Rouprêt
- GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Marko Babjuk
- Department of Urology, Second Faculty of Medicine, Hospital Motol, Charles University, Praha, Czech Republic
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Weill Cornell Medical College, New York, NY, USA
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Accuracy and prognostic value of variant histology and lymphovascular invasion at transurethral resection of bladder. World J Urol 2017; 36:231-240. [DOI: 10.1007/s00345-017-2116-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022] Open
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Gakis G, Fahmy O. Systematic Review and Meta-Analysis on the Impact of Hexaminolevulinate- Versus White-Light Guided Transurethral Bladder Tumor Resection on Progression in Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2016; 2:293-300. [PMID: 27500197 PMCID: PMC4969683 DOI: 10.3233/blc-160060] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Although there is evidence that hexaminolevulinate (HAL)-based transurethral bladder tumor resection (TURBT) improves the detection of Ta-T1 non-muscle-invasive bladder cancer (NMIBC) as well as carcinoma in situ there is uncertainty about its beneficial effects on progression. Material and Methods: A systematic literature search was conducted according to the PRISMA statement to identify studies reporting on HAL- vs. white-light (WL-) based TUR-BT in non-muscle invasive bladder cancer between 2000 and 2016. A two-stage selection process was utilized to determine eligible studies. Of a total of 294 studies, 5 (4 randomized and one retrospective) were considered for final analysis. The primary objective was the rate of progression. Results: The median follow-up for patients treated with HAL- and WL-TURBT was 27.6 (1–55.1) and 28.9 (1–53) months, respectively. Of a total of 1301 patients, 644 underwent HAL- and 657 WL-based TURBT. Progression was reported in 44 of 644 patients (6.8%) with HAL- and 70 of 657 patients (10.7%) with WL-TURBT, respectively (median odds ratio: 1.64, 1.10–2.45 for HAL vs. WL; p = 0.01). Data on progression-free survival was reported in a single study with a trend towards improved survival for patients treated with HAL-TURBT (p = 0.05). Conclusions: In this meta-analysis the rate of progression was significantly lower in patients treated with HAL- vs. WL-based TURBT. These results support the initiation of randomized trials on HAL with progression as primary endpoint.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, University Hospital Tübingen , Tübingen, Germany
| | - Omar Fahmy
- Department of Urology, University Putra Malaysia (UPM) , Selangor, Malaysia
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Abstract
Outcome prediction in patients with bladder cancer has improved through the development of nomograms and predictive models. However, integration of further characteristics such as lymphovascular invasion (LVI) might increase the accuracy and clinical utility of these instruments. Assessment and reporting of LVI in specimens from transurethral resection of the bladder tumour (TURBT) or biopsy in patients with non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) might enable improved staging, prognostication and clinical decision-making. In NMIBC, presence of LVI in TURBT and biopsy samples seems to be associated with understaging and increased risks of disease recurrence and progression. In MIBC, presence of LVI is associated with features of aggressive disease and predicts recurrence and survival. Integration of LVI status into predictive models might aid clinical decision-making regarding intravesical instillation schedules and regimens, early radical cystectomy in patients with high-grade T1 disease and perioperative chemotherapy. However, LVI assessment is hampered by insufficient reproducibility and reliability, lack of routine evaluation and limited concordance between findings in TURBT and radical cystectomy specimens. Standardization of the pathological criteria defining LVI is warranted to improve its reporting in routine clinical practice and its utility as a care-changing prognostic marker.
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