Pretreatment Staging of Urothelial Cancer similar to the reference standard of TURBT in differentiating MIBC from NMIBC. Ge et al [72] also found that preoperative contrast-enhanced US is highly efficient in discriminating Ta to T1 or low-grade bladder cancer from stage T2 or high-grade bladder cancer. Contrast-enhanced US shows high sensitivity, specificity, and diagnostic accuracy, making it a promising method for distinguishing T staging and grading of bladder cancer. Li et al [73] demonstrated that the combined use of contrast-enhanced US and DWI-MRI is more accurate in diagnosing bladder cancer than either method alone, making it a feasible and effective diagnostic approach for bladder cancer. Bone Scan Whole Body There are not many references available regarding the routine use of bone scans in UTUC separate from bladder cancer guidelines because of the lower frequency of occurrence of bone metastases in UTUC. There is also conflicting evidence for the use of whole-body bone scan to evaluate for bone metastases in bladder cancer. The incidence of metastases in patients with bladder cancer increases with tumor stage at time of diagnosis, and this statement may extend to the UTUC population [74]. Additionally, bone scanning may be limited to patients with bone pain and/or elevated levels of serum alkaline phosphatase. Further evaluation with radiographs and/or MRI can be helpful, and, if necessary, guided-needle biopsy can be definitive. CT Abdomen and Pelvis With IV Contrast There is limited evidence to support the use of CT abdomen and pelvis with IV contrast (separate from CTU protocol) in the pretreatment staging of UTUC although abdominopelvic lymph node involvement and metastases could still be evaluated this way, although its sensitivity for urothelial lesions is limited, and CTU/MRU are preferred and more comprehensive.
Pretreatment Staging of Urothelial Cancer. Pretreatment Staging of Urothelial Cancer similar to the reference standard of TURBT in differentiating MIBC from NMIBC. Ge et al [72] also found that preoperative contrast-enhanced US is highly efficient in discriminating Ta to T1 or low-grade bladder cancer from stage T2 or high-grade bladder cancer. Contrast-enhanced US shows high sensitivity, specificity, and diagnostic accuracy, making it a promising method for distinguishing T staging and grading of bladder cancer. Li et al [73] demonstrated that the combined use of contrast-enhanced US and DWI-MRI is more accurate in diagnosing bladder cancer than either method alone, making it a feasible and effective diagnostic approach for bladder cancer. Bone Scan Whole Body There are not many references available regarding the routine use of bone scans in UTUC separate from bladder cancer guidelines because of the lower frequency of occurrence of bone metastases in UTUC. There is also conflicting evidence for the use of whole-body bone scan to evaluate for bone metastases in bladder cancer. The incidence of metastases in patients with bladder cancer increases with tumor stage at time of diagnosis, and this statement may extend to the UTUC population [74]. Additionally, bone scanning may be limited to patients with bone pain and/or elevated levels of serum alkaline phosphatase. Further evaluation with radiographs and/or MRI can be helpful, and, if necessary, guided-needle biopsy can be definitive. CT Abdomen and Pelvis With IV Contrast There is limited evidence to support the use of CT abdomen and pelvis with IV contrast (separate from CTU protocol) in the pretreatment staging of UTUC although abdominopelvic lymph node involvement and metastases could still be evaluated this way, although its sensitivity for urothelial lesions is limited, and CTU/MRU are preferred and more comprehensive.