Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy

Purpose: Computerized tomography (CT) of the abdomen and pelvis is often ro utine in the preoperative staging assessment of invasive transitional cell carcinoma of the bladder. We determine the accuracy of staging CT findings, usefulness before planned extirpative surgery and impact on surgical manag ement of this disease. Materials and Methods: We retrospectively reviewed the medical records, inc luding radiographic, operative and pathological reports, of 82 consecutive cases. All patients presented with muscle invasive bladder tumors, were con sidered candidates for radical cystectomy and underwent preoperative stagin g CT of the abdomen and pelvis between July 1994 and June 1998. The ability of CT to provide additional staging information in terms of depth of tumor invasion, local extent of tumor, pelvic lymph node involvement and distant metastases was examined. We determined whether CT findings altered surgica l management for individual patients. Results: CT was able to discriminate depth of invasion in only 1 patient (1 .2%) and correctly identified extravesical tumor spread in 4 (4.9%). Lymph node and distant metastases were accurately determined in 4 (4.9%) and 2 (2 .4%) cases, respectively. The overall accuracy of CT was 54.9%, with an und er staging and over staging rate of 39.0% and 6.1%, respectively. CT provid ed accurate, additional staging information in only 8 cases (9.8%). Surgica l management was altered in 3 cases (3.7%) and only 1 (1.2%) avoided an unn ecessary operation as a result of CT findings. Conclusions: Staging CT of the abdomen and pelvis in patients with invasive bladder carcinoma has limited accuracy, mainly because of its inability to detect microscopic or small volume extravesical tumor extension and lymph node metastases, CT tends to under stage advanced disease and failed to alt er surgical management in nearly all of our cases.