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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
    Available online:
    Surgery in Motion
    Assessing the Feasibility and Accuracy of High-resolution Microultrasound Imaging for Bladder Cancer Detection and Staging
    Alberto Saita a,y, Giovanni Lughezzani a,y, Nicolo` Maria Buffi a,b,*, Rodolfo Hurle a, Luciano Nava c, Piergiuseppe Colombo d, Pietro Diana a,b, Vittorio Fasulo a,b, Marco Paciotti a,b, Grazia Maria Elefante d, Massimo Lazzeri a, Giorgio Guazzoni a,b, Paolo Casale a
    a Department of Urology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; b Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; c Department of Urology, Humanitas San Pio X, Milan, Italy; d Department of Pathology, Istituto Clinico Humanitas IRCCS—Clinical and Research Hospital, Rozzano, Milan, Italy
    Article info
    Article history:
    Associate Editor:
    Alexandre Mottrie
    Bladder cancer
    Muscle-invasive Ethylmalonyl Coenzyme A cancer
    Non-muscle-invasive bladder
    Microultrasound High-resolution ultrasound
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    Background: Magnetic resonance imaging (MRI) has been proposed as a staging tool for bladder cancer (BC), but its use has been limited by its high costs and limited availability. Microultrasound (mUS) is a novel technology capable of providing high-resolution images of the prostate.
    Objective: To test the feasibility of high-resolution mUS in patients diagnosed with BC and its ability to differentiate between non-muscle-invasive BC (NMIBC) and muscle-invasive BC (MIBC).
    Design, setting, and participants: This is an observational prospective study performed in 23 patients with a diagnosis of primary BC scheduled for an endoscopic treatment. Surgical procedure: Micro-US was performed before transurethral resection of bladder tumor using the ExactVu system with an EV29L 29-MHz side-fire transducer (Exact Imaging, Markham, Canada).
    Measurements: The endpoints were to test the feasibility, describe the normal bladder wall anatomy, identify the lesions, and compare the mUS findings with the histopatho-logical results.
    Results and limitations: Micro-US was accurate in differentiating the three layers of the bladder wall in all cases. Bladder cancers were clearly identified as heterogeneous structures protruding from the normal bladder wall. In 14 cases the lesions appeared confined to the lamina propria, and in all cases NMIBC was confirmed by the final pathological report. In the other patients, the lesions seemed to extend into the muscular layer, but MIBC was confirmed in five out of seven cases (71.4%) from the pathologist. The small sample size was the main limitation of the current study.
    Conclusions: Our findings Ethylmalonyl Coenzyme A showed that mUS is able to differentiate the bladder wall layers and identify the bladder cancer stage. Further studies with a larger population and imaging correlation with MRI are warranted before its introduction in clinical practice.
    Patient summary: In this report, a new imaging technique was tested for the characteri-zation of bladder cancer. Microultrasound appears to be feasible and capable of discrimi-nating between superficial and invasive tumors. © 2019 Published by Elsevier B.V. on behalf of European Association of Urology.
    y These authors contributed equally to the manuscript.
    Please cite this article in press as: Saita A, et al. Assessing the Feasibility and Accuracy of High-resolution Microultrasound Imaging for Bladder Cancer Detection and Staging. Eur Urol (2019),
    1. Introduction
    Bladder cancer (BC) is the second most common cancer in urology with respect to the incidence and prevalence [1]. BC is categorized as non-muscle-invasive BC (NMIBC) and muscle-invasive BC (MIBC), with the latter being typically associated with a poorer prognosis. Cancer staging and molecular subtype characterization are critical to the determination of the best therapeutic strategy [2]. The gold standard for assessing BC local stage is transurethral resection (TUR) used both to retrieve pathological samples for pathological analysis and to treat the patient. However, this approach is not risk free due to its invasiveness with the inherent surgical hazards, especially in patients with hemorrhagic diathesis.