The detection of carcinoma in situ (CIS) is essential for the management of high-risk non-muscle invasive bladder cancers. Here, we focused on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with photodynamic diagnosis (PDD) for the detection of CIS. A total of 45 patients undergoing pre-surgical DCE-MRI and PDD-assisted endoscopic surgery accompanied by biopsies of the eight segmentations were analyzed. Immunohistochemical analysis of the biopsies revealed hypervascularity of CIS lesions, a cause of strong submucosal contrast-enhancement. It was found that 56 (16.2%) of 344 biopsies had pathologically proven CIS. In the DCE-MRI, the overall sensitivity and specificity for detecting CIS were 48.2% and 81.9%, respectively. We set out two different combinations of PDD and DCE-MRI for detecting CIS. Combination 1 was positive when either the PDD or DCE-MRI were test-positive. Combination 2 was positive only when both PDD and DCE-MRI were test-positive. The overall sensitivity of combinations 1 and 2 were 75.0% and 37.5%, respectively (McNemar test, vs PDD alone; p = 0.041 and p < 0.001, respectively). However, the specificity was 74.0% and 91.7%, respectively (vs PDD alone; both p < 0.001). Our future goal is to establish 'MRI-PDD fusion transurethral resction of the bladder tumor (TURBT), which could be an effective therapeutic and diagnostic approach in the clinical management of high-risk disease.
Diagnostics (Basel, Switzerland). 2019 Sep 04*** epublish ***
Makito Miyake, Fumisato Maesaka, Nagaaki Marugami, Tatsuki Miyamoto, Yasushi Nakai, Sayuri Ohnishi, Daisuke Gotoh, Takuya Owari, Shunta Hori, Yosuke Morizawa, Yoshitaka Itami, Takeshi Inoue, Satoshi Anai, Kazumasa Torimoto, Tomomi Fujii, Keiji Shimada, Nobumichi Tanaka, Kiyohide Fujimoto
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. ., Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan., Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan., Department of Diagnostic Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan., Department of Pathology, Nara City Hospital, 1-50-1 Higashi kidera-cho, Nara, Nara 630-8305, Japan.