Thus, the authors advocate the routine use of bone scans in patients with MIBC. However, false-positive bone scans can occur, leading to the need for additional studies. Moreover, the routine use of bone scans in the staging of MIBC often leads to the need for additional downstream studies, resulting in treatment delays [79]. Furrer et al [80] concluded that routine staging bone scintigraphy has limited benefit in the staging of invasive bladder cancer and does not support its routine use. Overall, baseline bone scintigraphy led to a change in the intended management in only 1.7% of patients, with additional imaging being performed in 4% of patients. CT plays an important role in bladder cancer staging, detecting multifocal disease, extravesical extension, adenopathy, and metastases [2]. It can effectively identify bulky thickening of the bladder wall, perivesical tumor extension, lymphadenopathy, and distant metastases [34]. However, it is more effective for detecting T3b and T4 Pretreatment Staging of Urothelial Cancer CT is commonly used to determine nodal involvement, but relying on size alone is not reliable because small nodes may be metastatic and large nodes may be reactive [83]. CT cannot detect microscopic tumor metastases in nonenlarged lymph nodes [5]. CT accuracy for lymph node evaluation ranges from 73% to 92%, with a tendency to understage nodal involvement, particularly when based on short-axis nodal enlargement criteria of 1 cm [84]. Pelvic nodes are more challenging to recognize than paraaortic nodes, especially in thin patients, although asymmetry can be a useful sign [85]. The accuracy of CT for extravesical extension ranged from 40% to 92% with a mean of 74% in the study by Paik et al [27], and for predicting pathological tumor stage and lymph node metastases, accuracy was 49% and 54%, respectively, in the study by Tritschler et al [28].
Pretreatment Staging of Urothelial Cancer. Thus, the authors advocate the routine use of bone scans in patients with MIBC. However, false-positive bone scans can occur, leading to the need for additional studies. Moreover, the routine use of bone scans in the staging of MIBC often leads to the need for additional downstream studies, resulting in treatment delays [79]. Furrer et al [80] concluded that routine staging bone scintigraphy has limited benefit in the staging of invasive bladder cancer and does not support its routine use. Overall, baseline bone scintigraphy led to a change in the intended management in only 1.7% of patients, with additional imaging being performed in 4% of patients. CT plays an important role in bladder cancer staging, detecting multifocal disease, extravesical extension, adenopathy, and metastases [2]. It can effectively identify bulky thickening of the bladder wall, perivesical tumor extension, lymphadenopathy, and distant metastases [34]. However, it is more effective for detecting T3b and T4 Pretreatment Staging of Urothelial Cancer CT is commonly used to determine nodal involvement, but relying on size alone is not reliable because small nodes may be metastatic and large nodes may be reactive [83]. CT cannot detect microscopic tumor metastases in nonenlarged lymph nodes [5]. CT accuracy for lymph node evaluation ranges from 73% to 92%, with a tendency to understage nodal involvement, particularly when based on short-axis nodal enlargement criteria of 1 cm [84]. Pelvic nodes are more challenging to recognize than paraaortic nodes, especially in thin patients, although asymmetry can be a useful sign [85]. The accuracy of CT for extravesical extension ranged from 40% to 92% with a mean of 74% in the study by Paik et al [27], and for predicting pathological tumor stage and lymph node metastases, accuracy was 49% and 54%, respectively, in the study by Tritschler et al [28].