Diagnostic Imaging Pathways - Staging of Bladder Cancer
Population Covered By The Guidance
This pathway provides a diagnostic imaging algorithm for staging of patients with bladder cancer on histology.
Date Of Last Review Including Any Literature Review
This pathway was last modified in January 2012.
Date Of Next Review
This pathway will be reviewed in January 2013.
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
|SYMBOL||RRL||EFFECTIVE DOSE RANGE|
|Minimal||< 1 millisieverts|
- Accurate staging of bladder cancer allows for optimal treatment and prognostication of the individual patient. It is important to differentiate between non-muscle-invasive lesions and muscle invasive bladder lesions.
- Conventional rigid cystoscopy is the gold standard for diagnosis of bladder tumours, followed closely by flexible cystoscopy. Though small biopsies may be retrieved via a flexible cystoscope, rigid cystoscopy allows for tissue biopsy and formal tumour resection. Tissue histopathology provides further tumour staging information.
- Radiologic investigations are used in bladder cancer staging for further clarifying the extent of local disease and looking for nodal & metastatic spread.
- Distant metastatic spread is rarely seen at time of presentation. The most common sites of spread can be investigated appropriately using CXR (and/or CT chest) and CT abdomen.
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- MacVicar AD. BJU Int. Bladder cancer staging. 2000;86 Suppl 1:111-22. (Review)
- Pillai PL, Sooriakumaran P. Flexible cystoscopy: a revolution in urological practice. Br J Hosp Med. 2009;70(10):583-5. (Review)
- Battista G, Sassi C, Corcioni B, Bazzocchi A, Golfieri R, Canini R. Latest developments in imaging of bladder cancer. Expert Rev Anticancer Ther. 2010;10(6):881-94. (Review article)
- Witjes JA, Redorta JP, Jacqmin D, Sofras F, Malmström PU, Riedl C, et al. Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations. Eur Urol. 2010;57(4):607-14.
- Battista G, Sassi C, Corcioni B, Bazzocchi A, Golfieri R, Canini R. Latest developments in imaging of bladder cancer. Expert Rev Anticancer Ther. 2010;10(6):881-94.
- Vikram R, Sandler CM, Ng CS. Imaging and Staging of Transitional Cell Carcinoma: Part I, Lower Urinary Tract, AJR 2009; 192:1481-1487 (Review article)
- Paik ML, Scolieri MJ, Brown SL, Spirnak JP, Resnick MI.Fritz GA. Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. J Urol. 2000;163(6):1693-6. (Level III evidence)
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- Qu X, et al. Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: A meta-analysis. Eur J Radiol. 2010, article in press. (Level II evidence)
- Cowan NC, Crew JP. Imaging bladder cancer. Curr Opin Urol. 2010. 20:409-413. (Review article)
- Tekes A. Kamel I. Imam K. Szarf G. Schoenberg M. Nasir K. Thompson R. Bluemke D. Dynamic MRI of bladder cancer: evaluation of staging accuracy. Am J Roent. 2005;184(1):121-7 (Level III evidence)
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- Ozden et al. Effect of bladder carcinoma location on detection rates by ultrasonography and computed tomography. Urology. 2007;69(5):889-92. (Level III evidence)
- Itzchak Y., Singer D., Fischelovitch Y.: Ultrasonographic assessment of bladder tumors: 1. Tumor detection. J Urol. 1981;126:31-33. (Level III evidence)
- Abu-Yousef M.M., Narayana A.S., Franken E.A., et al: Urinary bladder tumors studied by cystosonography. Part 1: detection Radiology. 1984;153:223-226 (Level III evidence)
- Dershaw DD, Scher HI. Sonography in evaluation of carcinoma of bladder. Urology 1987;29:454-457. (Level III evidence)
- Qu X, et al. Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: A meta-analysis. Eur J Radiol (2010), article in press. (Level II evidence)
- Hillman BJ et al. Recognition of bladder tumors by excretory urography. Radiology. 1981;138(2):319-23. (Level III evidence)
- Sanderson KM, Rouprêt M. Upper urinary tract tumour after radical cystectomy for transitional cell carcinoma of the bladder: an update on the risk factors, surveillance regimens and treatments. BJU Int. 2007;100(1):11-6. (Review article)
- Kuroda M et al. Stage specific follow-up strategy after cystectomy for carcinoma of the bladder. Int J Urol. 2002; 9(3):129-133. (Level II evidence)
- Anjos DA. Etchebehere EC. Ramos CD. Santos AO. Albertotti C. Camargo EE. 18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. Journal of Nuclear Medicine. 2007;48(5):764-70. (Level III evidence)
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