The current diagnostic pathway for patients with muscle-invasive bladder cancer (MIBC), which involves with computed tomography urography, cystoscopy, and transurethral resection of the bladder (TURB) to histologically confirm MIBC, delays definitive treatment. The Vesical Imaging-Reporting and Data System (VI-RADS) has been suggested for MIBC identification using magnetic resonance imaging (MRI), but a recent randomized trial reported misclassification in one-third of patients. We investigated a new endoscopic biopsy device (Urodrill) for histological confirmation of MIBC and assessment of molecular subtype by gene expression in patients with VI-RADS 4 and 5 lesions on MRI. In ten patients, Urodrill biopsies were guided by MR images to the muscle-invasive portion of the tumor via a flexible cystoscope under general anesthesia. During the same session, conventional TURB was subsequently performed. A Urodrill sample was successfully obtained in nine of ten patients. MIBC was verified in six of nine patients, and seven of nine samples contained detrusor muscle. In seven of eight patients for whom a Urodrill biopsy sample was subjected to RNA sequencing, single-sample molecular classification according to the Lund taxonomy was feasible. No complications related to the biopsy device occurred. A randomized trial comparing this new diagnostic pathway for patients with VI-RADS 4 and 5 lesions and the current standard (TURB) is warranted.
We report on a novel biopsy device for patients with muscle-invasive bladder cancer that facilitates histology analysis and molecular characterization of tumor samples.
European urology open science. 2023 Jun 02*** epublish ***
Pontus Eriksson, Johanna Berg, Carina Bernardo, Johannes Bobjer, Johan Brändstedt, Annica Löfgren, Athanasios Simoulis, Gottfrid Sjödahl, Fredrik Sundén, Mats Wokander, Sophia Zackrisson, Fredrik Liedberg
Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden., Department of Imaging and Physiology, Skåne University Hospital, Malmö, Sweden., Department of Translational Medicine, Lund University, Malmö, Sweden., Department of Urology, Skåne University Hospital, Malmö, Sweden.