Accuracy of computed tomography for identifying locally advanced disease in patients with muscle-invasive bladder cancer

Introduction: To retrospectively evaluate the utility of computed tomography (CT) scanning in identifying patients with locally advanced bladder cancer. Methods: We performed an Institutional Review Board-approved review of 858 patients that underwent radical cystectomy (RC) from 2000 to 2008 at our institution. We selected patients with muscle-invasive bladder cancer (MIBC) who underwent up-front RC without neoadjuvant chemotherapy and who were assessed by preoperative CT scan. We limited this analysis to 48 CT scans obtained prior to transurethral resection. All CT scans were blinded and retrospectively re-read by a dedicated genitourinary radiologist (CSN) to identify tumor location, the presence of wall thickening, and evidence of extravesical disease (stranding or nodularity) or lymph node metastases. These radiologic fndings were compared with pathologic fndings. results: Pretransurethral resection CT scans were able to accurately identify tumor location in 66.7% of patients (sensitivity = 88.9%, specifcity = 33.3%) while lymph node assessment was accurate in 58.3% (sensitivity = 75%, specifcity = 62.5%). However, only 16.7% of patients with pathologic T3b disease were actually identifed on CT as having radiologic evidence of extravesical disease. Specifc radiologic signs suggestive of local disease extension, such as wall thickening, stranding, and nodularity correlated poorly with true pathologic T3b disease. conclusion: CT scanning has limits in its ability to accurately identify extravesical disease and lymph node spread in patients with MIBC. Investigations into additional or alternative means of clinical staging for bladder cancer patients are incredibly crucial.