Computed tomography as an adjunct to bimanual examination for staging bladder tumours

Computed tomography (CT scanning) has been undertaken in 51 patients with bladder tumours, 15 of whom subsequently had pathological examination of the bladder to confirm the extent of tumor spread. Concordance between the CT and pathological staging (80%) was as good as that between clinical and pathological staging (73%). Most of the inaccuracies of clinical staging were underestimations of the extent of muscle invasion, whilst the inaccuracy of CT involved overstaging. The principal areas where CT might improve the accuracy of clinical staging are in patients with invasive tumours who after transurethral resection have no mass palpable on bimanual examination, and in patients following radiotherapy who might be candidates for salvage cystectomy but in whom assessment of the spread of tumour is difficult because of post-irradiation fibrosis. Data from a much larger series are required to ascertain whether the additional information provided by CT will produce any improvement in patient management.