Transurethral resection of bladder tumour (TURBT) is central to the diagnosis of muscle-invasive bladder cancer (MIBC). With the oncological safety of TURBT unknown, staging inaccuracies commonplace, and correct treatment of MIBC potentially delayed, multiparametric magnetic resonance imaging (mpMRI) may offer rapid, accurate, and noninvasive diagnosis of MIBC. BladderPath is a randomised trial comparing risk-stratified (5-point Likert scale) image-directed care with TURBT for patients with newly diagnosed BC. To date, we have screened 279 patients and randomised 113. Here we report on the first 100 participants to complete staging: 48 in pathway 1 (TURBT) and 52 in pathway 2 (mpMRI for possible MIBC, Likert 3–5). Fifty of 52 participants designated Likert 1–2 (probable NMIBC) from both pathways were confirmed as having NMIBC (96%). Ten of 11 cases diagnosed as NMIBC by mpMRI have been pathologically confirmed as NMIBC, and 10/15 cases diagnosed as MIBC by mpMRI have been treated as MIBC (5 participants underwent TURBT). The specificity of mpMRI for identification of MIBC remains a limitation. These initial experiences indicate that it is feasible to direct possible MIBC patients to mpMRI for staging instead of TURBT. Furthermore, a 5-point Likert scale accurately identifies patients with low risk of MIBC (Likert 1–2), and flexible cystoscopy biopsies appear sufficient for diagnosing BC.
Funding/Support and role of the sponsor : BladderPath is funded by the National Institute for Health Research (NIHR; Health Technology Assessment Programme, project number 14/08/60). James W.F. Catto is funded by an NIHR Research Professorship (2019-24). The sponsor played a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and approval of the manuscript. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
© 2021 European Association of Urology
- Transurethral resection of bladder tumour
- magnetic resonance imaging
- bladder cancer
- clinical trial
- Magnetic resonance imaging
- Clinical trial
- Bladder cancer