Imaging of Bladder Cancer: Standard Applications and Future Trends

Diagnostic value of dual-layer spectral detector CT parameters for differentiating high- from low-grade bladder cancer

OBJECTIVES

This study aimed to investigate the diagnostic value of spectral parameters of dual-layer spectral detector computed tomography (DLCT) in distinguishing between low- and high-grade bladder cancer (BCa).

METHODS

This single-center retrospective study included pathologically confirmed BCa patients who underwent preoperative contrast-enhanced DLCT. Patients were divided into low- and high-grade groups based on pathology. We measured and calculated the following spectral CT parameters: iodine density (ID), normalized ID (NID), arterial enhancement fraction (AEF), extracellular volume (ECV) fraction, virtual non-contrast (VNC), slope of the attenuation curve, and Z effective (Zeff). Univariate and multivariable logistic regression analyses were used to determine the best predictive factors in differentiating between low- and high-grade BCa. We used receiver operating characteristic curve analysis to assess diagnostic performance and decision curve analysis to determine the net benefit.

RESULTS

The study included 64 patients (mean age, 64 ± 11.0 years; 46 men), of whom 42 had high-grade BCa and 22 had low-grade BCa. Univariate analysis revealed that differences in ID and NID in the corticomedullary phase, AEF, ECV, VNC, and Zeff images were statistically significant (p = 0.001-0.048). Multivariable analysis found that AEF was the best predictor of high-grade tumors (p = 0.006). With AEF higher in high-grade BCa, AEF results were as follows: area under the curve (AUC), 0.924 (95% confidence interval, 0.861-0.988); sensitivity, 95.5%; specificity, 81.0%; and accuracy, 85.9%. The cutoff valve of AEF for predicting high-grade BCa was 67.7%.

CONCLUSION

Using DLCT AEF could help distinguish high-grade from low-grade BCa.

CRITICAL RELEVANCE STATEMENT

This research demonstrates that the arterial enhancement fraction (AEF), a parameter derived from dual-layer spectral detector CT (DLCT), effectively distinguishes between high- and low-grade bladder cancer, thereby aiding in the selection of appropriate clinical treatment strategies.

KEY POINTS

This study investigated the value of dual-layer spectral detector CT in the assessment of bladder cancer (BCa) histological grade. The spectral parameter arterial enhancement fraction could help determine BCa grade. Our results can help clinicians formulate initial treatment strategies and improve prognostications.

[Use of clinical ultrasound in primary care: Hematuria]

Hematuria is a frequent entity in primary care. The differential diagnosis covers multiple causes: physiological, pharmacological, false hematuria and urological pathologies, being fundamental in its study to assess the possible malignant neoplastic causes. Urologic ultrasound is a non-invasive technique, using a 3.5-5MHz concave probe, with the patient lying supine and the bladder full. After anamnesis, physical examination, study of urinarium sediment and laboratory analysis to determine renal function, ultrasound allows the family doctor to confirm or rule out a large number of processes related to the etiology of hematuria: cysts and kidney masses, renal lithiasis, nephrocalcinosis, benign prostatic hyperplasia, polyps or vesical masses... However, this alone is not sufficient to establish a firm diagnosis in all cases. Currently, there is no general consensus about the most appropriate diagnostic sequence in the study of hematuria, and several clinical guidelines were chosen for the application of different strategies depending on the risk factors. However, ultrasound together with cystoscopy has been positioned as the most cost-effective diagnostic strategy in most cases. The use of ultrasound in the evaluation of the patient with hematuria in primary care allows a valuable diagnostic approach to be made, detecting warning signs and properly orienting the patient's referral to other levels, if necessary, early.

Cystitis glandularis: MR imaging characteristics in 27 patients

PURPOSE

To explore the diagnostic characteristics of cystitis glandularis (CG) using magnetic resonance imaging (MRI).

MATERIALS AND METHODS

A retrospective study was conducted on pathologically confirmed patients who underwent bladder MRI examination between January 2019 and November 2023. Image analysis was jointly conducted, with emphasis on lesion location, morphology, size, signal intensity, and pattern of enhancement, by two genitourinary radiologists with 22 and 15 years of experience, respectively.

RESULTS

A total of 27 patients with 27 lesions were included (median age 47 years, 24 males). The lesions were mostly located in the bladder trigone area (18/27). The lesions could be categorized as focal thickening (17/27), nodular (8/27), and diffuse thickening of the entire bladder (2/27) in morphological terms. On T2-weighted imaging (T2WI), 15 of 17 focal thickening lesions appeared as a slightly hyperintense thickened inner layer, with a higher signal in the center of the thickened inner layer, resembling a sandwich sign, and 6 of 8 nodular lesions were slightly hyperintense. On T1-weighted imaging (T1WI), 19 patients showed slight hypointensity. The lesions on DWI showed mainly high (5/27) and slightly high signal (21/27), with an average mean apparent diffusion coefficient (mADC) value of 2.171 ± 0.052 × 10-3mm2/s. Among the 23 patients who underwent dynamic contrast-enhanced (DCE) scanning, 18 lesions showed mild enhancement in the arterial phase (average 1.7 times comparing to unenhanced phase), and the degree of enhancement gradually increased in the venous and delayed phases (average 2.2 and 2.3 times compared to the unenhanced phase, respectively), showing a progressive enhancement pattern.

CONCLUSION

On MRI, the majority of CG manifest as focal thickening or nodules in the bladder trigone area, showing slight hyperintensity on T2WI, slight hypointensity on T1WI, and a progressive enhancement pattern, without significant restriction on DWI. Focal thickening lesions may exhibit a special sandwich sign.

Mathematical model of MMC chemotherapy for non-invasive bladder cancer treatment

Mitomycin-C (MMC) chemotherapy is a well-established anti-cancer treatment for non-muscle-invasive bladder cancer (NMIBC). However, despite comprehensive biological research, the complete mechanism of action and an ideal regimen of MMC have not been elucidated. In this study, we present a theoretical investigation of NMIBC growth and its treatment by continuous administration of MMC chemotherapy. Using temporal ordinary differential equations (ODEs) to describe cell populations and drug molecules, we formulated the first mathematical model of tumor-immune interactions in the treatment of MMC for NMIBC, based on biological sources. Several hypothetical scenarios for NMIBC under the assumption that tumor size correlates with cell count are presented, depicting the evolution of tumors classified as small, medium, and large. These scenarios align qualitatively with clinical observations of lower recurrence rates for tumor size ≤ 30[mm] with MMC treatment, demonstrating that cure appears up to a theoretical x[mm] tumor size threshold, given specific parameters within a feasible biological range. The unique use of mole units allows to introduce a new method for theoretical pre-treatment assessments by determining MMC drug doses required for a cure. In this way, our approach provides initial steps toward personalized MMC chemotherapy for NMIBC patients, offering the possibility of new insights and potentially holding the key to unlocking some of its mysteries.

Five historical innovations that have shaped modern urological surgery

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.

circRNA TATA-box binding protein associated factor 15 acts as an oncogene to facilitate bladder cancer progression through targeting miR-502-5p/high mobility group box 3

Circular RNAs (circRNAs) are key in regulating bladder cancer progression. This study explored the effects of circRNA TATA-box binding protein associated factor 15 (circTAF15) on bladder cancer progression. We enrolled 80 bladder cancer patients to examine the relationship between circTAF15 expression and clinical features. The function of circTAF15 on bladder cancer cell viability, proliferation, migration, invasion, and glycolysis was monitored by cell counting kit-8 assay, 5-Ethynyl-2'-deoxyuridine experiment, Transwell experiment, and glycolysis analysis. Dual luciferase reporter gene assay, RNA pull-down assay, and RNA immunoprecipitation assay were used to verify the binding between circTAF15 and miR-502-5p or between miR-502-5p and high mobility group box 3 (HMGB3). circTAF15 effect on in vivo growth of bladder cancer was investigated by xenograft tumor experiment. Quantitative real-time polymerase chain reaction, Western blot, and immunohistochemistry were implemented to investigate the expression levels of genes. circTAF15 was upregulated in bladder cancer patients, associated with unfavorable outcomes. circTAF15 knockdown attenuated bladder cancer cell viability, proliferation, migration, invasion, epithelial-mesenchymal transition, and glycolysis. circTAF15 suppressed miR-502-5p expression, and miR-502-5p inhibited HMGB3 expression. Low miR-502-5p expression was associated with unfavorable outcomes in bladder cancer patients. miR-502-5p silencing and HMGB3 overexpression counteracted the inhibition of circTAF15 knockdown on the malignant phenotype of bladder cancer cells. circTAF15 knockdown attenuated the in vivo growth of bladder cancer cells. circTAF15 enhanced the progression of bladder cancer through upregulating HMGB3 via suppressing miR-502-5p. circTAF15 may be a novel target to treat bladder cancer in the future.

SMMF: a self-attention-based multi-parametric MRI feature fusion framework for the diagnosis of bladder cancer grading

Background

Multi-parametric magnetic resonance imaging (MP-MRI) may provide comprehensive information for graded diagnosis of bladder cancer (BCa). Nevertheless, existing methods ignore the complex correlation between these MRI sequences, failing to provide adequate information. Therefore, the main objective of this study is to enhance feature fusion and extract comprehensive features from MP-MRI using deep learning methods to achieve an accurate diagnosis of BCa grading.

Methods

In this study, a self-attention-based MP-MRI feature fusion framework (SMMF) is proposed to enhance the performance of the model by extracting and fusing features of both T2-weighted imaging (T2WI) and dynamic contrast-enhanced imaging (DCE) sequences. A new multiscale attention (MA) model is designed to embed into the neural network (CNN) end to further extract rich features from T2WI and DCE. Finally, a self-attention feature fusion strategy (SAFF) was used to effectively capture and fuse the common and complementary features of patients' MP-MRIs.

Results

In a clinically collected sample of 138 BCa patients, the SMMF network demonstrated superior performance compared to the existing deep learning-based bladder cancer grading model, with accuracy, F1 value, and AUC values of 0.9488, 0.9426, and 0.9459, respectively.

Conclusion

Our proposed SMMF framework combined with MP-MRI information can accurately predict the pathological grading of BCa and can better assist physicians in diagnosing BCa.

Metabolomic Signatures of Treatment Response in Bladder Cancer

Bladder cancer (BC) stands as one of the most prevalent urological malignancies, with over 500 thousand newly diagnosed cases annually. Treatment decisions in BC depend on factors like the risk of recurrence, the type of tumor, and the stage of the disease. While standard therapeutic approaches encompass transurethral resection of the bladder tumor, radical cystectomy, and chemo- or immunotherapy, these methods exhibit limited efficacy in mitigating the aggressive and recurrent nature of bladder tumors. To overcome this challenge, it is crucial to develop innovative methods for monitoring and predicting treatment responses among patients with BC. Metabolomics is gaining recognition as a promising approach for discovering biomarkers. It has the potential to reveal metabolic disruptions that precisely reflect how BC patients respond to particular treatments, providing a revolutionary method to improve accuracy in monitoring and predicting outcomes. In this article, we present a comprehensive review of studies employing metabolomics approaches to investigate the metabolic responses associated with different treatment modalities for BC. The review encompasses an exploration of various models, samples, and analytical techniques applied in this context. Special emphasis is placed on the reported changes in metabolite levels derived from these studies, highlighting their potential as biomarkers for personalized medicine in BC.

Exosomal Long Non-Coding Ribonucleic Acid Ribonuclease Component of Mitochondrial Ribonucleic Acid Processing Endoribonuclease Is Defined as a Potential Non-Invasive Diagnostic Biomarker for Bladder Cancer and Facilitates Tumorigenesis via the miR-206/G6PD Axis

Bladder cancer (BLCA) is one of the cancers that is highly sensitive to specific non-invasive tumor biomarkers that facilitate early diagnosis. Exosome-derived long non-coding RNAs (lncRNAs) hold promise as diagnostic biomarkers for BLCA. In this study, we employed RNA-sequencing to compare the expression patterns of lncRNAs in urine exosomes from three BLCA patients and three healthy individuals. RMRP displayed the most significant differential expression. Elevated RMRP expression levels were observed in urinary and plasma exosomes from BLCA patients compared with those from healthy individuals. RMRP exhibited significant associations with certain BLCA patient clinicopathological features, including tumor stage, poor prognosis, and tumor grade. Combined diagnosis using RMRP in urine and plasma exosomes demonstrated a superior diagnostic performance with receiver operating characteristic curve analysis. RMRP was found to be related to BLCA tumor progression and the cell migration and invasion processes via the miR-206/G6PD axis both in vitro and in vivo. Mechanistically, RMRP serves as an miR-206 sponge, as suggested by dual-luciferase reporter assays and RNA immunoprecipitation. Our study suggests that the combined diagnosis of RMRP in urinary and plasma exosomes can serve as an excellent non-invasive diagnostic biomarker for BLCA patients. Additionally, targeting the RMRP/miR-206/G6PD axis holds promise as a therapeutic strategy for BLCA.

Recent advances in three-dimensional ultrasound virtual cystoscopy in modeling and local staging for urothelial carcinoma with histopathological correlation: a cohort prospective study

Background

Bladder urothelial carcinoma is an alarming urologic malignancy. Complex factors like modelling and local staging can affect treatment strategy. However, local staging, particularly the muscle invasion status, significantly influences decisions regarding treatment strategies. Therefore, this study aims to evaluate the novel advances of three-dimensional (3D) ultrasound (US) imaging to assess local staging in comparison with conventional cystoscopy.

Methods

Forty-three patients with painless haematuria and conventional cystoscopy findings of bladder mass underwent 3D US virtual cystoscopy. All specimens from conventional cystoscopy were processed histologically.

Results

Out of 43 participants, 18 (41.9%) patients proved to have invasive urothelial carcinoma by histopathology. The 3D US had a sensitivity of 97.5% and a specificity of 100%; however conventional cystoscopy was accurate in only 53.5% of the studied cases. Furthermore, in the case of malignant ulcers, mural extension into both the submucosal and the muscle layers was more readily appreciated in multiplanar images.

Conclusion

3D US updates are promising for use in bladder tumour modelling and local staging; however, they can be of value in evaluating mural and extramural tumour extent and have proven accuracy.

Neuroendocrine Carcinoma of the Urinary Bladder: CT Findings and Radiomics Signature

Background: We present a case series of Neuroendocrine Carcinoma of the Urinary Bladder (NECB) to analyse their radiologic appearance on CT, find a "Radiomic signature", and review the current literature. Methods: 14 CT cases of NECB were reviewed and compared with a control group of 42 patients with high-grade non-neuroendocrine bladder neoplasm for the following parameters: ring enhancement; implantation site; dimensions; density; margins; central necrosis; calcifications; number of lesions; wall thickness; depth of invasion in the soft tissue; invasion of fat tissue; invasion of adjacent organs; lymph-node involvement; abdominal organ metastasis. To extract radiomic features, volumes of interest of bladder lesions were manually delineated on the portal-venous phase. The radiomic features of the two groups were identified and compared. Results: Statistical differences among NECB and control group were found in the prevalence of male sex (100% vs. 69.0%), hydronephrosis (71.4% vs. 33.3%), mean density of the mass (51.01 ± 15.48 vs. 76.27 ± 22.26 HU); product of the maximum diameters on the axial plane (38.1 ± 59.3 vs. 14.44 ± 12.98 cm2) in the control group, trigonal region involvement (78.57% vs. 19.05%). About the radiomic features, Student's t-test showed significant correlation for the variables: "DependenceNonUniformity" (p: 0.048), "JointAverage" (p: 0.013), "LargeAreaLowGrayLevelEmphasis" (p: 0.014), "Maximum2DDiameterColumn" (p: 0.04), "Maximum 2DDiameterSlice" (p: 0.007), "MeanAbsoluteDeviation" (p: 0.021), "BoundingBoxA" (p: 0.022) and "CenterOfMassB" (p: 0.007). Conclusions: There is a typical pattern (male patient, large mass, trigonal area involvement) of NECB presentation on contrast-enhanced CT. Certain morphological characteristics and encouraging results about Radiomic features can help define the diagnosis.

Contrast-enhanced Ultrasound Combined With Elastography for the Evaluation of Muscle-invasive Bladder Cancer in Rats

OBJECTIVES

By comparing with the control group, we evaluated the usefulness of contrast-enhanced ultrasound (CEUS) combined with elastography for the assessment of muscle invasion by bladder cancer (MIBC) in a Sprague-Dawley (SD) rat model.

METHODS

In the experimental group, 40 SD rats developed in situ bladder cancer (BLCA) in response to N-methyl-N-nitrosourea treatment, whereas 40 SD rats were included in the control group for comparison. We compared PI, Emean , microvessel density (MVD), and collagen fiber content (CFC) between the two groups. In the experimental group, Bland-Altman test was used to assess the relationships between various parameters. The largest Youden value was used as the cut-off point, and binomial logistic regression analysis was performed to analyze the PI and Emean . Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic power of parameters, individually and in combination.

RESULTS

The PI, Emean , MVD, and CFC were significantly lower in the control group than in the experimental group (P < .05). The PI, Emean , MVD, and CFC were significantly higher for MIBC than for non-muscle-invasive bladder cancer (P < .05). There were significant correlations between PI and MVD, and between Emean and CFC. The diagnostic efficiency analysis showed PI had the highest sensitivity, CFC had the highest specificity, and PI + Emean had the highest diagnostic efficacy.

CONCLUSION

CEUS and elastography can distinguish lesions from normal tissue. PI, MVD, Emean , and CFC were useful for the detection of BLCA myometrial invasion. The comprehensive utilization of PI and Emean improved diagnostic accuracy and have clinical application.

PET in bladder cancer imaging

PURPOSE OF REVIEW

The aim of this study was to summarize the available evidence on different PET imaging modalities for the staging of patients diagnosed with bladder cancer (BCa). We further discuss the use of PET/computed tomography (CT) and PET/MRI with different radiopharmaceuticals to characterize tumour biology for treatment guidance.

RECENT FINDINGS

Available evidence supports the benefits of PET/CT in BCa staging due to its higher accuracy in the detection of nodal metastases compared with CT alone. The use of PET/MRI is of major future interest due to the higher soft tissue contrast of MRI, which might enable the early detection of the tumour in the bladder. For the time being, the sensitivity of PET/MRI is still too low, when it comes to the diagnosis of early-stage BCa. This is mainly due to the renal excretion of the commonly used [ 18 F]FDG PET tracer, wherefore small lesions in the wall of the bladder can be missed. Novel studies using PET radiopharmaceuticals to target immune checkpoints or other immune cell targets (immunoPET) demonstrated high uptake in tumour lesions with high PD-L1 expression. The use of immunoPET could therefore help identify BCa patients who exhibit PD-L1 positive tumours for systemic immune-therapy.

SUMMARY

PET/CT and PET/MRI seem to be promising imaging tools in BCa staging, especially for the detection of lymph node and distant metastases, as they are more accurate than conventional CT. Future clinical trials with novel radiopharmaceuticals and machine-learning driven PET-technologies bear the potential to help in the early detection, staging, monitoring and precision-medicine approach. Specifically, immunoPET is of high future interest, as it could help develop the concept of precision-medicine in the age of immunotherapy.

Multidetector computed tomography evaluation of bladder lesions

Background

Urinary bladder tumors are the most common type of tumors detected in patients with gross hematuria. Multidetector computed tomography (MDCT) is an accurate method for detecting bladder lesions. This review aims to describe the features of MDCT and the possible values for distinguishing these lesions in the bladder.

Main body

In this review, we discuss the role of MDCT in the evaluation of patients with bladder cancer and describe a broad spectrum of bladder lesions, including malignant bladder lesions beyond bladder cancer, benign bladder lesions, and diffuse bladder wall thickening.

Short conclusion

Familiarity with the clinical presentations and imaging features of bladder lesions can lead to more accurate diagnosis and appropriate management.

Micro-Ultrasound in the Diagnosis and Staging of Prostate and Bladder Cancer: A Comprehensive Review

Background and Objectives: Multiparametric magnetic resonance imaging (mpMRI) of the prostate and prostate-specific membrane antigen positron emission tomography (PSMA PET) are some examples of how the advancement of imaging techniques have revolutionized the diagnosis, staging, and consequently management of patients with prostate cancer (PCa). Although with less striking results, novel radiological modalities have also been proposed for bladder cancer (BCa) in recent years. Micro-ultrasound (MUS) is an imaging examination characterized by high real-time spatial resolution, recently introduced in the urological field. This article aimed to describe the current evidence regarding the application of MUS for the diagnosis and staging of PCa and BCa. Materials and Methods: We designed a narrative review. A comprehensive search in the MEDLINE, Scopus, and Cochrane Library databases was performed. Articles in English-language and published until July 2022 were deemed eligible. Retrospective and prospective primary clinical studies, as well as meta-analyses, were included. Results: MUS-guided prostate biopsy showed high sensitivity (0.91, 95% CI, 0.79-0.97) in the diagnosis of clinically significant PCa (csPCa). It was associated with a higher detection rate of csPCa than a systematic biopsy (1.18, 95% CI 0.83-1.68). No significant difference was found between MUS and mpMRI-guided biopsy in the total detection of PCa (p = 0.89) and in the detection of Grade Groups ≥ 2 (p = 0.92). The use of MUS to distinguish between non-muscle-invasive and muscle-invasive BCa was described, highlighting an up-staging with MUS only in a minority of cases (28.6%). Conclusions: Promising findings have emerged regarding the feasibility and accuracy of MUS in the diagnosis and staging of PCa and BCa. However, the available evidence is limited and should be considered preliminary.

The role of radiomics with machine learning in the prediction of muscle-invasive bladder cancer: A mini review

Bladder cancer is a common malignant tumor in the urinary system. Depending on whether bladder cancer invades muscle tissue, it is classified into non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). It is crucial to accurately diagnose the muscle invasion of bladder cancer for its clinical management. Although imaging modalities such as CT and multiparametric MRI play an important role in this regard, radiomics has shown great potential with the development and innovation of precision medicine. It features outstanding advantages such as non-invasive and high efficiency, and takes on important significance in tumor assessment and laor liberation. In this article, we provide an overview of radiomics in the prediction of muscle-invasive bladder cancer and reflect on its future trends and challenges.

Optimization of Preoperative Lymph Node Staging in Patients with Muscle-Invasive Bladder Cancer Using Radiomics on Computed Tomography

Approximately 25% of the patients with muscle-invasive bladder cancer (MIBC) who are clinically node negative have occult lymph node metastases at radical cystectomy (RC) and pelvic lymph node dissection. The aim of this study was to evaluate preoperative CT-based radiomics to differentiate between pN+ and pN0 disease in patients with clinical stage cT2-T4aN0-N1M0 MIBC. Patients with cT2-T4aN0-N1M0 MIBC, of whom preoperative CT scans and pathology reports were available, were included from the prospective, multicenter CirGuidance trial. After manual segmentation of the lymph nodes, 564 radiomics features were extracted. A combination of different machine-learning methods was used to develop various decision models to differentiate between patients with pN+ and pN0 disease. A total of 209 patients (159 pN0; 50 pN+) were included, with a total of 3153 segmented lymph nodes. None of the individual radiomics features showed significant differences between pN+ and pN0 disease, and none of the radiomics models performed substantially better than random guessing. Hence, CT-based radiomics does not contribute to differentiation between pN+ and pN0 disease in patients with cT2-T4aN0-N1M0 MIBC.

Magnetic Fields and Cancer: Epidemiology, Cellular Biology, and Theranostics

Humans are exposed to a complex mix of man-made electric and magnetic fields (MFs) at many different frequencies, at home and at work. Epidemiological studies indicate that there is a positive relationship between residential/domestic and occupational exposure to extremely low frequency electromagnetic fields and some types of cancer, although some other studies indicate no relationship. In this review, after an introduction on the MF definition and a description of natural/anthropogenic sources, the epidemiology of residential/domestic and occupational exposure to MFs and cancer is reviewed, with reference to leukemia, brain, and breast cancer. The in vivo and in vitro effects of MFs on cancer are reviewed considering both human and animal cells, with particular reference to the involvement of reactive oxygen species (ROS). MF application on cancer diagnostic and therapy (theranostic) are also reviewed by describing the use of different magnetic resonance imaging (MRI) applications for the detection of several cancers. Finally, the use of magnetic nanoparticles is described in terms of treatment of cancer by nanomedical applications for the precise delivery of anticancer drugs, nanosurgery by magnetomechanic methods, and selective killing of cancer cells by magnetic hyperthermia. The supplementary tables provide quantitative data and methodologies in epidemiological and cell biology studies. Although scientists do not generally agree that there is a cause-effect relationship between exposure to MF and cancer, MFs might not be the direct cause of cancer but may contribute to produce ROS and generate oxidative stress, which could trigger or enhance the expression of oncogenes.

A Case of Incidental Detection of Asymptomatic Bladder Cancer by Transvaginal Ultrasound

We report a case of an incidental diagnosis of early asymptomatic bladder cancer using transvaginal ultrasonography. The patient was a 68-year-old female without urinary symptoms. Transvaginal ultrasonography revealed a 2-cm papillary mass in the bladder mucosa. Urine cytology revealed the presence of atypical cells indicative of malignancy. Cystoscopy revealed a stalked papillary tumor at the apex of the posterior wall of the bladder. Transurethral resection of the bladder tumor was performed, and a 2-cm papillary tumor was resected. A pathological diagnosis of non-muscle-invasive bladder cancer was made.

FTIR Spectroscopic Imaging Supports Urine Cytology for Classification of Low- and High-Grade Bladder Carcinoma

Simple Summary

Human urine cytological samples were investigated using Fourier transform infrared spectroscopic imaging in terms of recognition of bladder cancer. The clustering of IR spectra of whole cytological smears revealed very good spectral correlation with normal urothelial cell features. Next, the combination of spectral information derived from unsupervised hierarchical cluster analysis and partial least square discriminant analysis (PLS-DA) classified normal vs. low- and high-grade bladder urothelial carcinoma with sensitivity and specificity of 90–97%.

Abstract

Bladder urothelial carcinoma (BC) is a common, recurrent, life-threatening, and unpredictable disease which is difficult to diagnose. These features make it one of the costliest malignancies. Although many possible diagnostic methods are available, molecular heterogeneity and difficulties in cytological or histological examination induce an urgent need to improve diagnostic techniques. Herein, we applied Fourier transform infrared spectroscopy in imaging mode (FTIR) to investigate patients’ cytology samples assigned to normal (N), low-grade (LG) and high-grade (HG) BC. With unsupervised hierarchical cluster analysis (UHCA) and hematoxylin-eosin (HE) staining, we observed a correlation between N cell types and morphology. High-glycogen superficial (umbrella) and low-glycogen piriform urothelial cells, both with normal morphology, were observed. Based on the spectra derived from UHCA, principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were performed, indicating a variation of protein content between the patient groups. Moreover, BC spectral cytology identified a low number of high-glycogen cells for which a shift of the carbohydrate/phosphate bands was also observed. Despite high cellular heterogeneity, PLS-DA was able to classify the spectra obtained. The voided urine FTIR cytology is one of the options that might be helpful in BC diagnosis, as high sensitivity and specificity up to 97% were determined.