Increase in Circulating Tumor Cells in Invasive Bladder Cancer After Transurethral Resection of Bladder Tumor

Typical multi-parametric magnetic resonance imaging in muscle-invasive bladder cancer. A: T2-Weighted image showing extension of intermediate signal intensity tumor to extravesical fat, representing invasion of the entire bladder wall. B: Dynamic contrast-enhanced image showing tumor with early enhancement that extended to the entire bladder wall and to extravesical fat. C: Diffusion-weighted image showing high-signal-intensity tumor that extends to the entire bladder wall and to extravesical fat. D: Apparent diffusion coefficient map showinq low-signal-intensity tumor that extends to the entire bladder wall and to extravesical fat. These figures suggest that a Vesical Imaging-Reporting and Data System Score of 5, which was composed of a T2-weighted imaging score of 5, dynamic contrast-enhanced imaging score of 5, and diffusion-weighted imaging score of 5, can be obtained. White and black arrows indicate the bladder tumor.

Flow cytometric detection of circulating tumor cells (CTCs) by the FISHMAN-R. CTCs are defined as cell nuclei-positive, cytokeratin (CK)-positive, epithelial cell adhesion molecule (EpCAM)-positive, and CD45-negative. After cells were detected by both forward scattered light (FSC) and side scattered light (SSC) (A), cell nuclei-positive cells were confirmed using 4’,6-diamidino-2-phenylindole (DAPI) (cell nucleus) (B). Both EpCAM-positive and CK-positive CTCs were identified using phycoerythrin (PE) against fluorescein isothiocyanate (FITC) density plots (C). EpCAM-positive cells were distinguished as CD45-negative using PE-Cy7 against PE density plots (D). CK-positive cells were distinguished as CD45-negative using PE-Cy7 against FITC density plots (E). Finally, the number of CTCs evaluated by FISHMAN-R was calculated using FlowJo software (F).

Comparison of the number of circulating tumor cells (CTCs) between non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer. A: Number of preoperative CTCs. B: Number of postoperative CTCs. C: Perioperative change in CTCs. Lines indicate the median, boxes indicate the interquartile range, and bars indicate the minimum and maximum. *Significantly different at p<0.05.

Correlation of the volume of irrigation fluid used during transurethral resection of bladder tumor with the number of CTCs postoperatively (A) and change in the number of CTCs (postoperative–preoperative) (B).