Potential Overstaging of Bladder Cancer by C-T Scanning

Yoon, Duck Ki; Koh, Sung Kun

Abstract

Clinical staging of bladder malignancy is important in assessing prognosis and planning therapy Clinical staging inaccuracies as high as high as 50% may occur when using resectional biopsy and bimannual examination. Various radiographic techniques have been used to aid in staging, including excretory urography, arteriography, lymphangiography, sonography and cystography. Seidelman et a1. reported an accuracy rate of 81% in C-T staging of bladder tumors. They suggested that C-T may be useful as a routine procedure in the initial staging of bladder malignancy but some others reported diagnostic under- or overstaging by C-T scanning. According to the report of Koss et al., most diagnostic errors in C-T staging of bladder carcinoma were related to the determination of perivesical fat involvement by tumor. Recently we experienced 4 cases of bladder carcinoma that was overstaged by C-T scanning. In 3 patients the scans were performed after cystoscopy and TUR biopsy of tumor mass, and overstaging occurred perhaps secondary to artifacts such as surgical edema produced at the time of TUR biopsy. In the other one, the scan was done before biopsy. All of them was undergone total cystectomy but perivesical or periprostatic fat involvement suggested on C-T scans was not found in the surgical pathological specimens.