title: Staging of muscle-invasive bladder cancer: can computerized tomography help us to decide on local treatment?
abstract: OBJECTIVE
  To assess the power of multi-detector row computerized tomography (MDCT) in daily routine as a basic staging procedure for the decision on local treatment of patients with bladder cancer.
  
  
  METHODS
  We retrospectively analysed 276 patients who had undergone radical cystectomy between 2004 and 2008 and correlated the MDCT findings with pathological findings, number of removed lymph nodes and type of urinary diversion.
  
  
  RESULTS
  Accuracy of MDCT in predicting pathological tumour stage was 49% (kappa coefficient, 0.23; P < 0.001). Overstaging occurred in 23.4%, and understaging occurred in 24.7%. Accuracy in predicting lymph node metastases was 54% (kappa coefficient, 0.04; P = 0.297). Overstaging and understaging occurred in 8.3 and 29.4%, respectively. Significantly more ileal conduits were performed in patients with high postoperative pathological tumour stages (P = 0.04) and positive lymph nodes (P = 0.013). In contrast, there was no correlation between preoperative CT tumour/nodal stage and the number of removed lymph nodes (P = 0.44 and P = 0.732, respectively), and between preoperative tumour stage and type of urinary diversion (P = 0.126).
  
  
  CONCLUSIONS
  MDCT as a preoperative staging procedure has a low accuracy in predicting the correct tumour and nodal stage, and therefore, it has little impact on decision-making for local treatment of muscle-invasive bladder cancer during radical cystectomy.
authors.affiliation: Department of Urology, University Hospital Großhadern, Ludwig Maximilians University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Stefan.Tritschler@med.uni-muenchen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Tritschler
authors.forename: Clarissa
authors.initials: C
authors.lastname: Mosler
authors.forename: Julia
authors.initials: J
authors.lastname: Straub
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Anno
authors.initials: A
authors.lastname: Graser
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D019459:Urothelium / Q000000981:diagnostic imaging / Q000473:pathology