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01-07-2019 | Magnetic Resonance Imaging | Oncology

Usefulness of the inchworm sign on DWI for predicting pT1 bladder cancer progression

Authors: Shugo Yajima, Soichiro Yoshida, Taro Takahara, Yuki Arita, Hiroshi Tanaka, Yuma Waseda, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Kazutaka Saito, Kazunori Kihara, Yasuhisa Fujii

Published in: European Radiology | Issue 7/2019

Abstract

Objective

To evaluate the significance of the presence or absence of an “inchworm sign” on DWI for the recurrence and progression of T1 bladder cancer.

Materials and methods

We retrospectively analyzed 91 patients with pT1 urothelial carcinoma who underwent DWI prior to transurethral resection between 2007 and 2016. DWI of the dominant tumors was scrutinized for inchworm signs at b = 1000 s/mm². The association of the presence of the inchworm sign with progression and recurrence was analyzed; progression was defined as recurrence to stage T2 or higher and/or N+, and/or M1.

Results

An inchworm sign was seen in 65 cases (71%), while it was absent in 26 cases. Among the 65, 25 (38%) had confirmed tumor recurrence, while in the remaining 26, 14 (54%) had confirmed recurrence (median time post TURB = 7.9 and 10.1 months for each). At the time of recurrence, the tumor had progressed in one (2%) inchworm-sign-positive and seven (27%) inchworm-sign-negative cases. The progression rate of inchworm-sign-negative cases was significantly higher than that of inchworm-sign-positive cases (hazard ratio = 17.2, p = 0.0017), whereas there was no significant difference in the recurrence rate between two groups. The absence of an inchworm sign and histological grade 3 were independent risk factors for progression (p < 0.001 and 0.010, respectively).

Conclusions

The absence of an inchworm sign on DWI was a significant prognostic factor for progression of T1 bladder cancer. Morphological evaluation of DWI signals may therefore be a useful adjunct to preoperative assessment of biological aggressiveness.

Key Points

• An inchworm sign is a simple diagnostic criterion that characterizes only the shape of the tumor signal on DWI, and potentially serves as an imaging biomarker to predict clinical aggressiveness.

• The absence of an inchworm sign on DWI is a significant indicator of progression of T1 bladder cancer.

Aldousari S, Kassouf W (2010) Update on the management of non-muscle invasive bladder cancer. Can Urol Assoc J 4:56–64CrossRefPubMedPubMedCentral

Fujii Y (2018) Prediction models for progression of non-muscle-invasive bladder cancer: a review. Int J Urol 25:212–218CrossRefPubMed

Herr HW (1997) Tumour progression and survival in patients with T1G3 bladder tumours: 15-year outcome. Br J Urol 80:762–765CrossRefPubMed

Sylvester RJ, van der Meijden AP, Oosterlinck W et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49:466–465 discussion 75-7CrossRefPubMed

Fernandez-Gomez J, Madero R, Solsona E et al (2009) Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol 182:2195–2203CrossRefPubMed

Cambier S, Sylvester RJ, Collette L et al (2016) EORTC nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non-muscle-invasive stage Ta-T1 urothelial bladder cancer patients treated with 1-3 years of maintenance bacillus Calmette-Guerin. Eur Urol 69:60–69CrossRefPubMed

Kurth KH, Denis L, Bouffioux C et al (1995) Factors affecting recurrence and progression in superficial bladder tumours. Eur J Cancer 31a:1840–1846CrossRefPubMed

Stephenson WT, Holmes FF, Noble MJ, Gerald KB (1990) Analysis of bladder carcinoma by subsite. Cystoscopic location may have prognostic value. Cancer 66:1630–1635CrossRefPubMed

Vukomanovic I, Colovic V, Soldatovic I, Hadzi-Djokic J (2012) Prognostic significance of tumor location in high-grade non-muscle-invasive bladder cancer. Med Oncol 29:1916–1920CrossRefPubMed

10.

Fujii Y, Fukui I, Kihara K et al (1998) Significance of bladder neck involvement on progression in superficial bladder cancer. Eur Urol 33:464–468CrossRefPubMed

11.

Kobayashi S, Fujii Y, Koga F et al (2014) Impact of bladder neck involvement on progression in patients with primary non-muscle invasive bladder cancer: a prospective validation study. Urol Oncol 32:38.e29–38.e36CrossRef

12.

Yoshida S, Masuda H, Ishii C et al (2011) Usefulness of diffusion-weighted MRI in diagnosis of upper urinary tract cancer. AJR Am J Roentgenol 196:110–116CrossRefPubMed

13.

Uchida Y, Yoshida S, Kobayashi S et al (2014) Diffusion-weighted MRI as a potential imaging biomarker reflecting the metastatic potential of upper urinary tract cancer. Br J Radiol 87:20130791CrossRefPubMedPubMedCentral

14.

Yoshida S, Takahara T, Kwee TC, Waseda Y, Kobayashi S, Fujii Y (2017) DWI as an imaging biomarker for bladder cancer. AJR Am J Roentgenol 208:1218–1228CrossRefPubMed

15.

Avcu S, Koseoglu MN, Ceylan K, Bulut MD, Unal O (2011) The value of diffusion-weighted MRI in the diagnosis of malignant and benign urinary bladder lesions. Br J Radiol 84:875–882CrossRefPubMedPubMedCentral

16.

Kobayashi S, Koga F, Yoshida S et al (2011) Diagnostic performance of diffusion-weighted magnetic resonance imaging in bladder cancer: potential utility of apparent diffusion coefficient values as a biomarker to predict clinical aggressiveness. Eur Radiol 21:2178–2186CrossRefPubMed

17.

Takeuchi M, Sasaki S, Ito M et al (2009) Urinary bladder cancer: diffusion-weighted MR imaging--accuracy for diagnosing T stage and estimating histologic grade. Radiology 251:112–121CrossRefPubMed

18.

Orsola A, Trias I, Raventos CX et al (2005) Initial high-grade T1 urothelial cell carcinoma: feasibility and prognostic significance of lamina propria invasion microstaging (T1a/b/c) in BCG-treated and BCG-non-treated patients. Eur Urol 48:231–238 discussion 8CrossRefPubMed

19.

Smits G, Schaafsma E, Kiemeney L, Caris C, Debruyne F, Witjes JA (1998) Microstaging of pT1 transitional cell carcinoma of the bladder: identification of subgroups with distinct risks of progression. Urology 52:1009–1013 discussion 13-4CrossRefPubMed

20.

Kondylis FI, Demirci S, Ladaga L, Kolm P, Schellhammer PF (2000) Outcomes after intravesical bacillus Calmette-Guerin are not affected by substaging of high grade T1 transitional cell carcinoma. J Urol 163:1120–1123CrossRefPubMed

21.

Cheng L, Neumann RM, Weaver AL, Spotts BE, Bostwick DG (1999) Predicting cancer progression in patients with stage T1 bladder carcinoma. J Clin Oncol 17:3182–3187CrossRefPubMed

22.

Babjuk M, Bohle A, Burger M et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71:447–461CrossRefPubMed

23.

Platz CE, Cohen MB, Jones MP, Olson DB, Lynch CF (1996) Is microstaging of early invasive cancer of the urinary bladder possible or useful? Mod Pathol 9:1035–1039PubMed

24.

Lin WC, Chen JH (2015) Pitfalls and limitations of diffusion-weighted magnetic resonance imaging in the diagnosis of urinary bladder cancer. Transl Oncol 8:217–230CrossRefPubMedPubMedCentral

25.

Panebianco V, Narumi Y, Altun E et al (2018) Multiparametric magnetic resonance imaging for bladder cancer: development of VI-RADS (vesical imaging-reporting and data system). Eur Urol 74:294–306CrossRefPubMedPubMedCentral

Title: Usefulness of the inchworm sign on DWI for predicting pT1 bladder cancer progression
Authors: Shugo Yajima
Soichiro Yoshida
Taro Takahara
Yuki Arita
Hiroshi Tanaka
Yuma Waseda
Minato Yokoyama
Junichiro Ishioka
Yoh Matsuoka
Kazutaka Saito
Kazunori Kihara
Yasuhisa Fujii
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Biomarkers
Published in: European Radiology / Issue 7/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06119-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Usefulness of the inchworm sign on DWI for predicting pT1 bladder cancer progression

Abstract

Objective

Materials and methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusions

Key Points

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