[Clinical-pathology relationship in bladder cancer].

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Muscle-invasive bladder cancer requires accurate staging for treatment planning.
• Radical cystectomy is a primary treatment option for this condition.
• Pre-operative imaging plays a crucial role in determining the extent of disease.

Purpose of the Study:

• To evaluate the effectiveness of Computerized Axial Tomography (TAC) in the pre-operative staging of muscle-invasive bladder cancer.
• To assess the accuracy of TAC in determining bladder (pT) and lymph node (pN) involvement.
• To analyze the impact of TAC findings on surgical management decisions.

Main Methods:

• Retrospective cohort study of 63 patients undergoing radical cystectomy for bladder cancer.
• Comparison of TAC staging with pathological anatomy results (TNM classification).
• Evaluation of TAC's impact on surgical approach.

Main Results:

• TAC correctly staged the bladder in only 28.6% of cases, with understaging in 50.8% and overstaging in 20.6%.
• TAC sensitivity for bladder cancer decreased with more advanced stages, while specificity increased (44% for pT2 to 94% for pT4).
• Lymph node staging by TAC was accurate in 73.5% of cases, primarily in node-negative patients, with low sensitivity (28%) and specificity (55%).

Conclusions:

• Computerized Axial Tomography (TAC) has a limited impact on the clinical staging of muscle-invasive bladder cancer.
• The primary benefit of TAC is in patients with suspected advanced disease.
• Restricting TAC use to these cases could significantly reduce costs with minimal risk of inappropriate surgical management.