The Clinical Features of Incidentally Diagnosed Urothelial Bladder Cancer: A Retrospective Data Analysis

Abstract

<b><i>Introduction:</i></b> The aim of this study was to evaluate the prevalence and clinical features of incidental bladder cancer (BC) diagnosis, with special emphasis on possible associations between incidental diagnosis and primary disease stage or grade. <b><i>Methods:</i></b> We retrospectively included 501 consecutive patients who underwent transurethral resection of bladder tumor and were diagnosed with primary urothelial carcinoma of the bladder between January 2013 and February 2021 in a university hospital. The type of diagnosis (incidental or nonincidental), patient baseline characteristics and primary stage and grade were studied for interdependencies. <b><i>Results:</i></b> 28.5% of all patients and 19.8% of high grade (HG) BC patients had been diagnosed incidentally, most commonly with ultrasound. Incidental diagnosis was associated with lower primary stage and grade of the disease. Most importantly, on multivariable analysis, which included baseline patient characteristics and type of diagnosis, in the subgroup of HG BC patients, muscle-invasive BC (MIBC) or metastatic disease was three times less likely to be diagnosed incidentally than non-MIBC (odds ratio: 0.31, 95% confidence interval: 0.14–0.71, <i>p</i> = 0.006). <b><i>Conclusions:</i></b> The study is first to demonstrate that incidental diagnosis of HG BC may be surprisingly prevalent and associated with lower rates of muscle invasion or metastatic disease.

The Impact of the Initial Clinical Presentation of Bladder Cancer on Histopathological and Morphological Tumor Characteristics

“…Our study revealed that asymptomatic patients who were incidentally diagnosed through imaging studies or identified during the evaluation of asymptomatic microscopic hematuria exhibited more favorable histopathological and morphological bladder cancer features compared to symptomatic patients. While previous studies have established an association between symptomatic presentation and a more advanced bladder cancer grade and stage, our study adds novel insights by identifying additional factors of interest, including the presence of concomitant CIS, larger tumor size, and increased number of tumors [ 14 , 15 ]. These findings may be attributed to the early detection of bladder cancer in asymptomatic patients.…”

“…Two recent retrospective studies have investigated incidentally diagnosed bladder cancer and compared the pathological features of incidental cases detected through imaging techniques with symptomatic cases. In both studies, the criteria for defining study groups slightly differed from ours, as they included patients with microscopic hematuria in the symptomatic group [ 14 , 15 ]. Since microscopic hematuria without additional symptoms is a sign of a potential disease observed by a physician, rather than a symptom, we classified patients with microscopic hematuria into the asymptomatic group [ 11 ].…”

“…In contrast, our investigation also included multiple regression analyses to examine the relationship between symptomatic presentation and unfavorable bladder cancer features more comprehensively, taking into account the influence of demographic predictors [ 14 ]. Kamecki et al reported that incidental diagnosis was associated with a significantly lower likelihood of having high-grade (OR 0.52) and muscle-invasive or metastatic bladder cancer (OR 0.19) [ 15 ]. Similarly, our results showed that symptomatic patients had nearly 3.5 times higher odds of being diagnosed with high-grade bladder cancer and almost 6 times higher odds of having T2 stage bladder cancer.…”

Systematic Evaluation of Imaging Features of Early Bladder Cancer Using Computed Tomography Performed before Pathologic Diagnosis

“…As no standardized screening algorithm for bladder cancer detection currently exists, systematic opportunistic screening for bladder abnormalities would represent a paradigm shift among radiologists, potentially facilitating early diagnosis [44]. We believe that during abdominopelvic imaging performed for alternative indications, a concentrated bladder survey could significantly aid in bladder cancer detection, particularly in highrisk patients (those over 50 years of age, especially patients with a history of tobacco abuse and/or industrial chemical exposures).…”