To evaluate whether high-frequency ultrasound (HF-US) and ultrasound-guided core needle biopsy (CNB) can accurately detect muscle-invasive bladder cancer (MIBC) in an ex-vivo setting.
In this prospective study, patients undergoing radical cystectomy (RC) for urothelial carcinoma underwent ex-vivo HF-US of the extirpated bladder to assess depth of tumor invasion (ultrasound stage, usT). In a subset, HF-US guided CNB of the opened bladder targeted the deepest region of tumor invasion (cnbT). Ultrasound images and biopsy specimens were interpreted by a blinded GU-radiologist and pathologist, respectively and were compared with RC pathologic stage (pT). Co-primary endpoints were accuracy of HF-US and CNB in identifying MIBC.
Among 54 patients, 47 underwent HF-US and 32 underwent CNB. HF-US demonstrated an accuracy of 89.6% for detecting MIBC, with sensitivity 95.0%, specificity 85.7%, and negative predictive value (NPV) 96.0%. CNB accuracy was 90.6%, with specificity and positive predictive value of 100%. In patients undergoing both modalities (n=25), a combined approach demonstrated 92.0% accuracy, 100% sensitivity, and 100% NPV. Conventional clinical staging had significantly lower accuracy (55.6%), particularly following neoadjuvant systemic therapy (40.0%). Diagnostic performance of HF-US and CNB remained high in patients treated with neoadjuvant systemic or intravesical therapy.
HF-US and ultrasound-guided CNB were highly accurate in determining MIBC and specifically demonstrated excellent NPV. These findings support further investigation of in-vivo endoscopic ultrasound and CNB staging to improve risk stratification and treatment selection in bladder cancer.
Urology. 2026 Jun 23 [Epub ahead of print]
Daniel S Roberson, Michael K Wang, Matthew T McLeay Ii, Nancy Wei, Theodora Potretzke, Sounak Gupta, John C Cheville, Ryan Kern, Derek Lomas, Lance Mynderse, Abhinav Khanna, Paras Shah, Matthew K Tollefson, R Jeffrey Karnes, Stephen A Boorjian, Vidit Sharma
Department of Urology, Mayo Clinic, Rochester, MN., Department of Radiology, Rochester, MN., Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN., Department of Pulmonology Mayo Clinic, Rochester, MN., Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: .