title: Discrepancy between clinical staging through bimanual palpation and pathological staging after cystectomy.
abstract: OBJECTIVE
  In muscle invasive bladder cancer (MIBC), careful clinical staging is essential for patient counseling and decision-making. Bimanual palpation (BP) is an integral part and guideline advice of clinical staging. Until now, however, the value of BP has never been studied. With this study, we aim to determine the accuracy of clinical staging through BP.
  
  
  METHODS
  Detailed clinical data were collected from a population-based series of 1,409 patients with MIBC, diagnosed between 1989 and 2005, in the region of the Comprehensive Cancer Centre East in The Netherlands. Selected were all patients who underwent BP (n = 738). Preoperative tumor-stage (cT-stage) determined through BP was compared with post-cystectomy pT-stage. Contingency tables were made to determine the correlation between cT-stage and pT-stage.
  
  
  RESULTS
  In 18 of 142 patients in whom BP showed an organ-confined tumor, the tumor was unresectable (pT4) at the time of surgery. Four out of 9 patients who had a suspected T4 tumor on BP but who underwent cystectomy anyway appeared to have operable tumors at cystectomy. In 87 patients (57.6%), accurate staging through BP was observed. In 17 patients (11.3%), clinical overstaging was found, and in 47 patients, (31.1%) clinical understaging.
  
  
  CONCLUSIONS
  Frequently, pT-stage after cystectomy does not correlate with preoperative cT-stage based on BP. Discrepancy was observed in 42% of the patients: in 11%, clinical overstaging and in 31%, clinical understaging. Based on these data, some caution is suggested when interpreting the outcome of BP. Prospective data is needed for a more formal evaluation of the staging accuracy of BP.
authors.affiliation: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. M.Ploeg@uro.umcn.nl
authors.forename: Martine
authors.initials: M
authors.lastname: Ploeg
authors.forename: Lambertus A L M
authors.initials: LA
authors.lastname: Kiemeney
authors.forename: Geert A
authors.initials: GA
authors.lastname: Smits
authors.forename: Henk
authors.initials: H
authors.lastname: Vergunst
authors.forename: Andre C
authors.initials: AC
authors.lastname: Viddeleer
authors.forename: Arno D H
authors.initials: AD
authors.lastname: Geboers
authors.forename: Hans
authors.initials: H
authors.lastname: van Berkel
authors.forename: Erika
authors.initials: E
authors.lastname: van Boven
authors.forename: Katja K H
authors.initials: KK
authors.lastname: Aben
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D003657:Decision Making; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods; D009426:Netherlands; D010173:Palpation / Q000379:methods; D012042:Registries; D015203:Reproducibility of Results; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000601:surgery*