Novel Imaging Techniques Prior to Surgical Management of Invasive Bladder Cancer: A Systematic Review.
Mahmoud Hijazi, Jacob Hanna, Jennifer Sykes et al.
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In 30 seconds
This PRISMA-guided systematic review assessed novel imaging for detecting muscle invasion and nodal disease before surgical management of invasive bladder cancer. It included 33 studies encompassing 4,689 patients. Across 23 studies, VI-RADS performance depended on the threshold: at three or greater, median sensitivity was 94% and specificity 82%; at four or greater, these were 84% and 92%, respectively. For nodal staging, PET approaches showed promise, with fibroblast activation protein inhibitor tracers reporting the highest sensitivity. The authors conclude that prospective multicenter validation is needed.
Key findings
- For muscle invasion, VI-RADS at a threshold of three or greater had median sensitivity of 94% and specificity of 82%.
- At a VI-RADS threshold of four or greater, median sensitivity was 84% and specificity was 92%.
- For nodal staging, fluorodeoxyglucose PET/CT sensitivity ranged from 23 to 81%, compared with 13 to 47% for conventional CT.
- Fibroblast activation protein inhibitor tracers had sensitivity of 82 to 100% and specificity of 82 to 90%.
Why it matters
Accurate preoperative assessment of muscle invasion and nodal disease can inform staging and treatment planning in invasive bladder cancer. The review indicates that imaging performance varies by modality and threshold, so results should be interpreted in context. Its findings identify promising approaches while underscoring that stronger prospective validation is needed before their role in management is established.
What to keep in mind
The review reports heterogeneous diagnostic performance across included studies and concludes that prospective multicenter validation is needed.