Clinical pitfalls in diagnosis of nonmuscle-invasive bladder cancer

Vincenzo Serretta, Cristina Scalici Gesolfo

Risultato della ricerca: Articlepeer review

Abstract

Current global economic crisis imposes healthcare system to reduce unnecessary investigations and increaseearly detection of tumors, to decrease the costs of an advanced disease. Several diagnostic pitfalls may occurdealing with bladder cancer (BC), particularly in nonmuscle-invasive (NMIBC) one. Hematuria, the commonestsign in NMIBC, is often underestimated. Urinary cytology is highly specific for high-grade tumors, but has a lowsensitivity for low-grade BC, is operator dependent, and not always obtainable in clinical practice. Numerousurinary tests are available to ameliorate the accuracy of cytology, but none of them is routinly used in urologicalpractice. Ultrasound could hardly detect a small bladder tumor, especially if located in the bladder neck or in theanterior wall. Computed tomography (CT) is widely adopted as an alternative to conventional urography, but itsusefulness in patients with hematuria is still debated. MRI has a higher accuracy than CT for staging BC and evaluatethe bladder-wall invasion. A negative cystoscopy cannot exclude Tis and should be accompanied by urinarycytology in patients with suspected Tis or high-risk NMIBC; however, new techniques such as narrow band imaging(NBI) and photodynamic (PDD) increase the detection rate of BC and flat lesions. Nearly half of all diagnosticresections present omission of muscle in the specimen or its mention in the pathology report, which is associatedwith an increased mortality. An adequate muscle sampling during endoscopic resection is mandatory, particularlyin patients with high-grade disease. Recognition of pitfalls in diagnosis and management of BC represents the firststep for a correct approach.
Lingua originaleEnglish
pagine (da-a)S1-S4
Numero di pagine4
RivistaUrologia
Volume82
Stato di pubblicazionePublished - 2015

All Science Journal Classification (ASJC) codes

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