Interobserver variability in CT findings contributes to the limited accuracy of CT in detecting extravesical tumor spread, infiltration of extravesical organs, and lymph node involvement [29]. Yuan et al [86] demonstrated that CT could help surgeons determine the extent of pelvic lymph node dissection, with lower-stage tumors requiring less extensive nodal dissection, reducing the risk of complications. However, Horn et al [87] found that the sensitivity of CT imaging for the detection of lymph node metastases was low, whereas the specificity was relatively high. Rajesh et al [30] conducted a study on 201 patients with bladder UC who underwent CT whole-body staging at the time of diagnosis to evaluate distant metastatic disease. Results showed that 6% of patients had distant metastatic spread, with retroperitoneal lymph nodes being the most common site. None of the patients with NMIBC had distant metastases. Peritoneal metastases were observed in 7.6% to 16% of cases, with a higher frequency in cases of atypical variant histology. One study reported CT findings of peritoneal metastases in 8 out of 105 patients, which were associated with poor prognosis [88]. In another study, peritoneal metastasis was observed in 24 out of 150 patients, occurring more frequently in those with atypical histology, including squamous cell carcinoma, adenocarcinoma, small cell carcinoma, and undifferentiated tumors [45]. CT Abdomen and Pelvis Without and With IV Contrast 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 MIBC. There is no relevant literature documenting the additional benefit of CT without and with IV contrast, relative to CT with IV contrast in this setting. CTU and MRU are of greater usefulness because they allow for the comprehensive evaluation of the genitourinary tract, as well as the assessment of retroperitoneal and pelvic lymph nodes (see CTU and MRU sections).
Pretreatment Staging of Urothelial Cancer. Interobserver variability in CT findings contributes to the limited accuracy of CT in detecting extravesical tumor spread, infiltration of extravesical organs, and lymph node involvement [29]. Yuan et al [86] demonstrated that CT could help surgeons determine the extent of pelvic lymph node dissection, with lower-stage tumors requiring less extensive nodal dissection, reducing the risk of complications. However, Horn et al [87] found that the sensitivity of CT imaging for the detection of lymph node metastases was low, whereas the specificity was relatively high. Rajesh et al [30] conducted a study on 201 patients with bladder UC who underwent CT whole-body staging at the time of diagnosis to evaluate distant metastatic disease. Results showed that 6% of patients had distant metastatic spread, with retroperitoneal lymph nodes being the most common site. None of the patients with NMIBC had distant metastases. Peritoneal metastases were observed in 7.6% to 16% of cases, with a higher frequency in cases of atypical variant histology. One study reported CT findings of peritoneal metastases in 8 out of 105 patients, which were associated with poor prognosis [88]. In another study, peritoneal metastasis was observed in 24 out of 150 patients, occurring more frequently in those with atypical histology, including squamous cell carcinoma, adenocarcinoma, small cell carcinoma, and undifferentiated tumors [45]. CT Abdomen and Pelvis Without and With IV Contrast 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 MIBC. There is no relevant literature documenting the additional benefit of CT without and with IV contrast, relative to CT with IV contrast in this setting. CTU and MRU are of greater usefulness because they allow for the comprehensive evaluation of the genitourinary tract, as well as the assessment of retroperitoneal and pelvic lymph nodes (see CTU and MRU sections).