Reinterpretation of imaging studies by a specialized breast
radiologist has the potential to reveal new cancers and reduce the
number of unnecessary interventions, such as biopsy, which
might other wise lead to patient anxiety and psychologic distress.
DWI as an Imaging Biomarker
for Bladder Cancer
Bladder cancer is the second most
common genitourinary cancer among
men and the ninth most common
among women in the United States. In
2016, there were 76,960 new cases reported and an estimated 16,390 deaths
reported from bladder cancer. At initial
presentation, two-thirds of all cases
are diagnosed as non–muscle-invasive
bladder cancer (stage T1 or less),
which can be conservatively managed
using transurethral resection of the bladder and intravesical instillation therapy. However, during follow-up evaluation, one-third of high-grade T1 bladder cancers have progressed with
muscle invasion or incurable metastatic disease. In muscle-invasive bladder cancer, more extensive treatment, including radical
cystectomy, is needed. The clinical course of bladder cancer differs significantly among patients, and accurate prediction of its
biologic behavior is needed.
DWI, a noninvasive, functional imaging technique, can serve as
a biomarker that is useful for characterizing the pathophysiology
of various types of malignancies including bladder cancer. This
unique imaging technique provides qualitative and quantitative information on histologic and biologic characteristics of bladder cancer that can be important to customizing therapeutic approaches.
The emerging evidence demonstrates the utility of DWI in
every step of managing bladder cancer patients. Furthermore,
the whole-body DWI technique has substantial promise for staging and follow-up of patients with or at risk of metastatic disease.
However, the application of DWI as an imaging biomarker for
bladder cancer is just emerging. There are still major challenges
to validate and standardize data acquisition and analysis.
AJR in Brief: Taking a Second Look
and Finding New Solutions
[We created this service] because
clinically significant changes in radiologic
interpretation are believed to influence
surgical management.—Kristen Coffey
DWI can serve as a biomarker that is useful for
characterizing the pathophysiology of various
types of malignancies including bladder
In the June, July, and August 2017 issues of the AJR, journal
authors explore the feasibility of second reviews for breast imaging, enhanced evaluations to detect biomarkers for bladder cancer screenings, MRIs for living liver donors, and more.
Second-Opinion Review of
Breast Imaging at a Cancer
Center: Is It Worthwhile?
Second-opinion reviews of breast
imaging studies at a cancer center influence clinical management and add
value to patient care.
While the process can be time-consuming and labor intensive, a retrospective analysis of 200 cases reviewed
for a second time showed a change in
interpretation of 55 cases. These changes included 26 recommendations that led to a major change in
management. Additional cancer was detected in 5% of patients,
and biopsy was averted for 4%. The reviews were conducted by a
team of radiologists and researchers at Memorial Sloan Kettering
Cancer Center, in New York, New York.
Often, patients with suspicious findings detected on breast
imaging performed in community medical facilities are referred
by their physicians to a specialized cancer center for consultation
and potential initiation of treatment, or they seek the second
opinion themselves. Integrated multidisciplinary reviews of
breast imaging studies and breast cancer pathologic results have
been found to alter treatment strategy.
“At our cancer center, specialized breast radiologists offer a
consultation service to new patients of breast surgeons at the
center by providing second-opinion review of all imaging studies
obtained at outside facilities. [We created this service] because
clinically significant changes in radiologic interpretation are believed to influence surgical management,” said study coauthor
Kristen Coffey, of the department of radiology at Memorial Sloan
Kettering Cancer Center.
Journal authors discuss the benefits of looking at imaging with new perspectives.