Radiography Intravenous Urography Excretory urography, previously used for urothelium evaluation in the renal collecting systems and ureters, has now been replaced by CTU and MRU. Excretory urography has a lower sensitivity of 50% to 70% for detecting upper urinary tract lesions, compared with CTU [37]. In fact, a study comparing the accuracy of CTU and excretory urography for detecting and localizing upper urinary tract cancer showed that CTU had higher sensitivity, specificity, and overall accuracy rates of 93.5%, 94.8%, and 94.2%, respectively, compared with 80.4%, 81.0%, and 80.8%, respectively, for excretory urography [37]. Therefore, once bladder cancer is diagnosed, CTU or MRU is preferred for staging and treatment planning, and routine IVU is typically unnecessary. US Kidneys and Bladder Retroperitoneal There is no relevant literature to support the use of ultrasound (US) kidneys and bladder retroperitoneal in the evaluation of NMIBC. US Pelvis (Bladder) US is not commonly used for bladder cancer staging, because transabdominal grayscale US can lead to overstaging of superficial tumors in 48% to 49% of cases and understaging of invasive tumors in 5% to 11% of cases [64]. However, US can be useful in evaluating hematuria. In a study of 1,007 patients with gross hematuria [65], US had a sensitivity of 63% and a specificity of 99% in detecting bladder cancer. Another study by Fang et al [66] evaluated 214 new cases of bladder cancer with pathological correlation, reporting an overall accuracy of 79% for local staging with transabdominal US, with 10% overstaging and 12% understaging. However, transabdominal US is less Pretreatment Staging of Urothelial Cancer accurate for detecting stage T3 and T4 disease compared with T1 and T2 disease [64]. Some researchers have correlated sonographically determined tumor height-to-length ratio with depth of tumor invasion on transabdominal US [67].
Pretreatment Staging of Urothelial Cancer. Radiography Intravenous Urography Excretory urography, previously used for urothelium evaluation in the renal collecting systems and ureters, has now been replaced by CTU and MRU. Excretory urography has a lower sensitivity of 50% to 70% for detecting upper urinary tract lesions, compared with CTU [37]. In fact, a study comparing the accuracy of CTU and excretory urography for detecting and localizing upper urinary tract cancer showed that CTU had higher sensitivity, specificity, and overall accuracy rates of 93.5%, 94.8%, and 94.2%, respectively, compared with 80.4%, 81.0%, and 80.8%, respectively, for excretory urography [37]. Therefore, once bladder cancer is diagnosed, CTU or MRU is preferred for staging and treatment planning, and routine IVU is typically unnecessary. US Kidneys and Bladder Retroperitoneal There is no relevant literature to support the use of ultrasound (US) kidneys and bladder retroperitoneal in the evaluation of NMIBC. US Pelvis (Bladder) US is not commonly used for bladder cancer staging, because transabdominal grayscale US can lead to overstaging of superficial tumors in 48% to 49% of cases and understaging of invasive tumors in 5% to 11% of cases [64]. However, US can be useful in evaluating hematuria. In a study of 1,007 patients with gross hematuria [65], US had a sensitivity of 63% and a specificity of 99% in detecting bladder cancer. Another study by Fang et al [66] evaluated 214 new cases of bladder cancer with pathological correlation, reporting an overall accuracy of 79% for local staging with transabdominal US, with 10% overstaging and 12% understaging. However, transabdominal US is less Pretreatment Staging of Urothelial Cancer accurate for detecting stage T3 and T4 disease compared with T1 and T2 disease [64]. Some researchers have correlated sonographically determined tumor height-to-length ratio with depth of tumor invasion on transabdominal US [67].