title: Discordance between preoperative and postoperative bladder cancer location: implications for partial-bladder radiation.
abstract: OBJECTIVE
  There is strong interest in partial-bladder radiation whether as a boost or definitive therapy to limit long-term toxicity. It is unclear that a standard preoperative examination can accurately identify all sites of disease within the bladder. The purpose of this study was to determine the correlation between preoperative localization of bladder tumors with postoperative findings to facilitate partial-bladder radiation techniques when appropriate.
  
  
  METHODS
  We examined patients with clinically staged T1-T4 invasive transitional cell carcinoma (TCC) or TCC with variant histology with no history of radiation or partial cystectomy undergoing radical cystectomy. Patients were scored as "under-detected" if a bladder site was involved with invasive disease (≥T1) at the time of cystectomy, but not identified preoperatively. Patients were additionally scored as "widely under-detected" if they had postoperative lesions that were not identified preoperatively in a given site, nor in any adjacent site. Rates of under-detected and widely under-detected lesions, as well as univariate and multivariate association between clinical variables and under-detection, were evaluated using logistic regression.
  
  
  RESULTS
  Among 222 patients, 96% (213/222) had at least 1 area of discordance. Fifty-eight percent of patients were under-detected in at least 1 location, whereas 12% were widely under-detected. Among 24 patients with a single site of disease on preoperative evaluation, 21/24 (88%) had at least 1 under-detected lesion and 14/24 (58%) were widely under-detected. On multivariate analysis, only solitary site of preoperative disease was associated with increased levels of under-detection of invasive disease (OR = 4.161, 95% CI, 1.368-12.657).
  
  
  CONCLUSIONS
  Our study shows a stark discordance between preoperative and postoperative localization of bladder tumors. From a clinical perspective, incomplete localization of all sites of disease within the bladder may lead to marginal misses when a partial-bladder technique is used.
authors: Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Benjamin
authors: B
authors: Goldsmith
authors: Kai
authors: K
authors: Tucker
authors: Robert Greg
authors: RG
authors: Conway
authors: Jiwei
authors: J
authors: He
authors: Thomas
authors: T
authors: Guzzo
authors: Justin
authors: J
authors: Bekelman
authors: Curtiland
authors: C
authors: Deville
authors: Neha
authors: N
authors: Vapiwala
authors: S Bruce
authors: SB
authors: Malkowicz
authors: John
authors: J
authors: Christodouleas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D015653:Cystectomy; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011184:Postoperative Period; D057234:Preoperative Period; D012044:Regression Analysis; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery