Pretreatment Staging of Urothelial Cancer The overall accuracy of local bladder cancer staging in the literature is variable. A retrospective study looked at 778 patients from 3 academic centers over a 19-year time period who had undergone a radical cystectomy and compared clinical to pathologic stage [26]. In these patients, pathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. However, given the 20-year time period that data were collected, the advances in CT technique and imaging prevalence may have affected results. To improve local staging, various techniques including CT cystograms and CT urograms have been investigated. Paik et al [27] found an overall accuracy of 55%, with a 39% understaging and a 21% false-negative for extravesical spread. In a retrospective review of 276 patients, Tritschler et al [28] found the accuracy of CT in predicting pathological tumor stage was 49% and the accuracy for predicting lymph node metastases was 54%. They concluded that multidetector CT had little impact on decision making for local treatment of MIBC during radical cystectomy. Another study by the same group [29] found that there was significant interobserver variability in CT findings, which might contribute to the limited accuracy of CT in the detection of extravesical tumor spread, infiltration of extravesical organs, and lymph node involvement. CT Abdomen and Pelvis Without and With IV Contrast Although there is no relevant literature to support the use of CT abdomen and pelvis without and with IV contrast (separate from CTU) in the evaluation of NMIBC, it may be useful in some clinical situations. However, CTU and MRU are of greater usefulness because they allow for a more comprehensive evaluation of the genitourinary tract, as well as assessment of retroperitoneal and pelvic lymph nodes (see CTU and MRU sections).
Pretreatment Staging of Urothelial Cancer. Pretreatment Staging of Urothelial Cancer The overall accuracy of local bladder cancer staging in the literature is variable. A retrospective study looked at 778 patients from 3 academic centers over a 19-year time period who had undergone a radical cystectomy and compared clinical to pathologic stage [26]. In these patients, pathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. However, given the 20-year time period that data were collected, the advances in CT technique and imaging prevalence may have affected results. To improve local staging, various techniques including CT cystograms and CT urograms have been investigated. Paik et al [27] found an overall accuracy of 55%, with a 39% understaging and a 21% false-negative for extravesical spread. In a retrospective review of 276 patients, Tritschler et al [28] found the accuracy of CT in predicting pathological tumor stage was 49% and the accuracy for predicting lymph node metastases was 54%. They concluded that multidetector CT had little impact on decision making for local treatment of MIBC during radical cystectomy. Another study by the same group [29] found that there was significant interobserver variability in CT findings, which might contribute to the limited accuracy of CT in the detection of extravesical tumor spread, infiltration of extravesical organs, and lymph node involvement. CT Abdomen and Pelvis Without and With IV Contrast Although there is no relevant literature to support the use of CT abdomen and pelvis without and with IV contrast (separate from CTU) in the evaluation of NMIBC, it may be useful in some clinical situations. However, CTU and MRU are of greater usefulness because they allow for a more comprehensive evaluation of the genitourinary tract, as well as assessment of retroperitoneal and pelvic lymph nodes (see CTU and MRU sections).