| Part one Value of conventional ultrasound in diagnosis and grading of bladder cancerObjective In this part,bladder cancer,inverted papilloma and cystitis glandularis were included in the study,and the conventional ultrasound features of bladder cancer and benign lesions were compared and summarized.In addition,the conventional ultrasound features of low-grade and high-grade bladder urothelial carcinoma were compared and analyzed,and the value of conventional ultrasound in bladder urothelial carcinoma grading was evaluated.Methods The clinical data and conventional ultrasound features of 142 patients with pathologically confirmed bladder lesions,in the Lanzhou University Second Hospital from March 2021 to September 2022,were retrospectively analyzed.According to the pathological results,the subjects were divided into bladder cancer group(n=109),inverted papilloma group(n=19)and cystitis glandularis group(n=14),and the differences in ultrasound features among the three groups were compared.Urothelial carcinoma included in the bladder cancer group was then divided into highgrade group(n=70)and low-grade group(n=36)according to pathological findings,and the conventional ultrasound features were compared between the two groups.Logistic regression analysis and receiver operating characteristic curve(ROC)were used to evaluate the value of conventional ultrasound features in urothelial carcinoma grading.Results There were significant differences in the maximum diameter,shape,location,edge,echo,echo uniformity and aspect ratio of the lesions between the bladder cancer group and the inverted papilloma group(all P<0.05);there were significant differences in the maximum diameter,shape,location and blood flow grade between the bladder cancer group and cystitis glandularis group(all P<0.05);and there were significant differences in the maximum diameter,shape,echo,echo uniformity and aspect ratio between the inverted papilloma group and cystitis glandularis group(all P<0.05).There were significant differences in transverse diameter,longitudinal diameter,echo uniformity,blood flow grade and hyperechoic shape between low-grade group and high-grade group(all P<0.05).Multi-factors combination had good diagnostic efficacy in urothelial carcinoma grading,with a sensitivity of 75.0%,and a specificity of 80.0%,and an area under the ROC curve of 0.812(95%CI: 0.724-0.900,P=0.000).Logistic regression analysis showed that transverse diameter,longitudinal diameter,echo uniformity,blood flow grade and hyperechoic shape of the lesion were not independent risk factors for urothelial carcinoma grading(all P>0.05).Conclusion Conventional ultrasound features are helpful for differential diagnosis of bladder cancer and have high application value in urothelial carcinoma grading.Part two Value of contrast-enhanced ultrasound in the diagnosis and grading of bladder cancerObjective The contrast-enhanced ultrasound(CEUS)features and quantitative parameters of bladder cancer and benign lesions were compared and analyzed.The quantitative parameters of CEUS in low-grade and high-grade bladder urothelial carcinoma were analyzed and compared,and the value of CEUS in bladder urothelial carcinoma grading was evaluated.Methods A total of 124 patients who underwent bladder CEUS in the Lanzhou University Second Hospital from March 2021 to September 2022 and confirmed by histopathology were retrospectively included in the study.All patients were divided into benign group(n=15)and bladder cancer group(n=109)according to pathological findings,CEUS features were compared between the two groups,and the diagnostic performance of CEUS for bladder cancer was calculated using contingency tables.Among them,the lesions that were quantitatively analyzed using Vuebox quantitative analysis software were selected and divided into bladder cancer group(n=54)and benign group(n=8),and the CEUS quantitative parameters were compared between the two groups.Then urothelial carcinoma in bladder cancer group was divided into highgrade group(n=32)and low-grade group(n=20),CEUS quantitative parameters were compared between the two groups,and Logistic regression analysis and ROC curve were used to evaluate the value of CEUS quantitative parameters in urothelial carcinoma grading.Results In the comparison of CEUS features between bladder cancer and benign groups,there were significant differences in time of wash in,and enhancement degree(all P<0.05),and the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of CEUS in the diagnosis of bladder cancer were98.2%,60.0%,94.7%,90.0%,and 93.5%,respectively.There were significant differences in peak enhancement(PE),PE difference,Wash-in rate(Wi R),Wash-in perfusion index(Wi PI)and Wash-out rate(Wo R)between the benign and bladder cancer groups(all P<0.05).Comparison of quantitative parameters between low-grade and high-grade groups showed significant differences among PE,PE difference,Wi R,Wi PI,and Wo R(all P<0.05).The sensitivity,specificity and AUC of the multi-factors combination in bladder urothelial carcinoma grading were 85.0%,56.2%,and 0.770(95%CI: 0.635-0.904,P=0.001)respectively.Logistic regression analysis showed that PE,PE difference,Wi R,Wi PI and Wo R were not independent risk factors for urothelial carcinoma grading(all P>0.05).Conclusion CEUS features and quantitative parameters are helpful for differential diagnosis of bladder cancer and CEUS quantitative parameters have certain application value in the urothelial carcinoma grading.Part three Value of Vesical Imaging-Reporting and Data system based on conventional ultrasound and CEUS in bladder cancer stagingObjective To investigate the value of Vesical Imaging-Reporting and Data system(VI-RADS)based on conventional ultrasound and CEUS in bladder cancer staging.Methods According to previous studies of conventional ultrasound and CEUS in bladder cancer staging and VI-RADS in multiparametric magnetic resonance imaging(MRI),we established a VI-RADS based on conventional ultrasound and CEUS.42 bladder cancer patients who underwent bladder CEUS in the Lanzhou University Second Hospital from March 2021 to September 2022 and had definite pathological stage were retrospectively included to verify the diagnostic efficacy of this system.Conventional ultrasound and CEUS images were analyzed by two sonographers,respectively,and scored in strict accordance with the VI-RADS based on conventional ultrasound and CEUS.The scoring results were compared with the pathological results to evaluate the diagnostic performance of this scoring system when different scores were used as cutoff values to determine muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC),respectively.Inter-reader agreement was evaluated using the Kappa test.Results The final pathologic results showed 28 NMIBCs and 14 MIBCs.When VI-RADS ≥4 was used as the cutoff value to differentiate MIBC,the sensitivity,specificity,PPV,NPV,accuracy,and AUC of this scoring system were 82.1%,92.9%,72.2%,95.8%,85.7%,and 0.875(95%CI: 0.759-0.991,P=0.000),respectively.Good inter-reader agreement was found for VI-RADS scores based on conventional ultrasound and CEUS(Kappa=0.808,P=0.000).Conclusion The VI-RADS based on conventional ultrasound and CEUS has good diagnostic efficacy in bladder cancer staging. |
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