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The Use of High-Resolution Micro-Ultrasound in Diagnosing and Staging Bladder Cancer - Expert Commentary

High-resolution micro-ultrasound is a promising technology in the staging of prostate cancer but has not been well studied in bladder cancer patients. A recent paper published by Saita et al. in European Urology evaluated the accuracy and feasibility of micro-ultrasound in detecting and staging bladder cancer. The investigators studied 23 bladder cancer patients using a micro-ultrasound system before the transurethral resection of their bladder tumors. They evaluated the accuracy of micro-ultrasound in identifying bladder wall layers, non-muscle-invasive bladder cancer, and muscle-invasive cancers in comparison to histopathological results.

The study found that micro-ultrasound was accurate in identifying the three layers of the bladder wall. In 14 patients, lesions were limited to the lamina propria. These patients were all confirmed to be non-muscle-invasive bladder cancer lesions pathologically. In 7 patients, micro-ultrasound showed lesions that extended beyond the lamina propria to the muscular layer. Histopathologic examination confirmed muscle-invasive lesions in five out of the seven patients. The other two patients were diagnosed with non-muscle-invasive bladder cancer. In two patients, micro-ultrasound imaging was not feasible patients due to an enlarged prostate.

This important study demonstrates the feasibility of micro-ultrasound in resolving the layers of the bladder wall. This imaging modality accurately staged bladder cancers and discriminated between non-muscle invasive and muscle-invasive lesions. Additional studies to validate these results are needed. Defining the operating characteristics and the cost-effectiveness of micro-ultrasound imaging in larger cohorts is required to establish its clinical utility in bladder cancer patients.


Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

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References:
1. Saita A, Lughezzani G, Buffi NM, Hurle R, Nava L, Colombo P, Diana P, Fasulo V, Paciotti M, Elefante GM, Lazzeri M, Guazzoni G, Casale P. Assessing the Feasibility and Accuracy of High-resolution Microultrasound Imaging for Bladder Cancer Detection and Staging. Eur Urol. 2019 Apr 10. pii: S0302-2838(19)30277-5. doi: 10.1016/j.eururo.2019.03.044.