A Systematic Review of Advanced Imaging Modalities for Bladder Cancer: Comparative Analysis of Strengths and Limitations
DOI:
https://doi.org/10.36283/ziun-pjmd14-3/079Keywords:
Bladder Cancer, Optical Imaging, Diagnostic Imaging, PET, CT, MRIAbstract
Background: Bladder cancer was seen to be amongst the most common urological malignancies, which required very sensitive approaches of detection that were also reliable for grading to improve patient outcomes. Diagnostic potential of various imaging modalities such as Multiparametric MRI (mpMRI), Contrast-Enhanced Ultrasound (CEUS), Blue Light Cystoscopy (BLC), Confocal Laser Endomicroscopy (CLE), Positron Emission Tomography (PET), Narrow Band Imaging (NBI) and Optical Coherence Tomography (OCT) were explored. This systematic review assessed the effectiveness of these imaging modalities to detect and stage bladder cancer to improve treatment outcomes and patient satisfaction.
Methods: The review was conducted using PRISMA guidelines. The published research was found in PubMed and Web of Science databases from August to November 24, 2024. Studies were included if it used one of seven advanced imaging modalities with reported sensitivity and specificity. Studies were excluded if they were not in English and were animal based. Two independent reviewers selected studies and reported the sensitivity and specificity of imaging modalities. Results were synthesized narratively by two independent reviewers. The QUADAS-2 assessment tool was used to assess risk or bias in the studies.
Results: Out of 112 articles, 41 studies were included. The sensitivity of mpMRI in differentiating NMIBC from MIBC varied from 88 to 95.4%. CEUS was found to be a noninvasive alternative for detecting lesions with a sensitivity of 94% and specificity of 90%, though operator dependency was noted. AI-augmented BLC achieved specificity from 88–95% for carcinoma in situ detection. CLE and OCT provided a real time means for lesion characterization, with OCT showing greater specificity (85–97.8%) than CLE (66.5–74.8%) for CIS. NBI and PET also showed promising accuracies.
Discussion: mpMRI and CEUS along with BLC had proven to be promising in the detection of bladder cancer sensitivity, while OCT had demonstrated the best CIS specificity. NBI and CLE were seen to be emerging techniques that had potential in resource limited settings but that needed further clinical validation. It was found that PET was crucial to detecting distant metastasis despite it being costly. Standardization and integration of these modalities into clinical practice would improve diagnostic precision as well as patient care.
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