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Bladder Cancer: Diagnosis and Evaluation
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=== <span style="color:#ff0000">Upper urinary tract imaging</span> === * '''<span style="color:#ff0000">2021 CUA NMIBC Guidelines: Upper urinary tract imaging is recommended in the initial workup of patients suspected to have bladder cancer</span>''' * '''<span style="color:#ff0000">2016 AUA NMIBC Guidelines: A clinician should perform upper urinary tract imaging as a component of the initial evaluation of a patient with bladder cancer</span>''' ** Campbell’s: patients with solitary or limited low-grade Ta lesions do not need imaging unless they have concomitant hematuria, owing to the very low risk of extravesical disease ** The timing of initial upper tract imaging for bladder cancer is not clear, but it should likely be risk stratified and generally within 6 months of initial diagnosis. * '''Upper tract imaging is usually performed before TUR to identify:''' ** '''Other sources of hematuria''' ** '''Assess the extravesical urothelium because of the “field change” nature of urothelial carcinoma''' *** '''In patients with a known history of bladder cancer, upper tract tumors occur in <5% of patients''' **** The overall incidence of significant findings with imaging of the upper tracts in patients with newly diagnosed bladder cancer is low but increases with tumors of the trigone, CIS, and high-risk disease. **'''Although it is optimal to obtain cross-sectional imaging before TUR, if imaging is obtained subsequently, it should be delayed ≈7 days post-procedure to minimize inflammatory artifact,''' which can be mistaken for T3 disease * '''Modality''' **'''Contrast-based axial imaging, such as CT or MRI are recommended.''' *** The sensitivity and specificity of CT in detecting nodal metastasis ranges from 31-50% and 68%-100%, respectively *** MRI is generally considered to be more accurate than CT in detecting local tumor stage; however, reports vary in the literature *** Retrograde pyelogram and intravenous urography may also be used when CT or MRI are unavailable. *** US alone may not provide sufficient anatomic detail for upper urinary tract imaging during the work-up of bladder cancer * '''Findings''' ** '''Hydronephrosis on cross-sectional imaging is suspicious for muscle invasion/extravesical disease'''
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