ACR Appropriateness Criteria® Pretreatment Staging of Muscle-Invasive Bladder Cancer

Expert Panel on Urologic Imaging:

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Muscle-invasive bladder cancer (MIBC) has a tendency toward urothelial multifocality and is at risk for local and distant spread, most commonly to the lymph nodes, bone, lung, liver, and peritoneum. Pretreatment staging of MIBC should include imaging of the urothelial upper tract for synchronous lesions; imaging of the chest, abdomen, and pelvis for metastases; and MRI pelvis for local staging. CT abdomen and pelvis without and with contrast (CT urogram) is recommended to assess the urothelium and abdominopelvic organs. Pelvic MRI can improve local bladder staging accuracy. Chest imaging is also recommended with chest radiograph usually being adequate. FDG-PET/CT may be appropriate to identify nodal and metastatic disease. Chest CT may be useful in high-risk patients and those with findings on chest radiograph. Nonurogram CT and MRI of the abdomen and pelvis are usually not appropriate, and neither is radiographic intravenous urography, Tc-99m whole body bone scan, nor bladder ultrasound for pretreatment staging of MIBC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)S150-S159
JournalJournal of the American College of Radiology
Volume15
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Urinary Bladder Neoplasms
Pelvis
Thorax
Muscles
Abdomen
Urography
Urinary Bladder
Guidelines
Whole Body Imaging
Bone and Bones
Urothelium
Peritoneum
Expert Testimony
Radiology
Lymph Nodes
Neoplasm Metastasis
Lung
Liver
Therapeutics

Keywords

  • Appropriate Use Criteria
  • Appropriateness Criteria
  • AUC
  • Bladder cancer
  • CT
  • MRI
  • Muscle-invasive bladder cancer
  • Staging
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

ACR Appropriateness Criteria® Pretreatment Staging of Muscle-Invasive Bladder Cancer. / Expert Panel on Urologic Imaging:.

In: Journal of the American College of Radiology, Vol. 15, No. 5, 01.05.2018, p. S150-S159.

Research output: Contribution to journalArticle

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abstract = "Muscle-invasive bladder cancer (MIBC) has a tendency toward urothelial multifocality and is at risk for local and distant spread, most commonly to the lymph nodes, bone, lung, liver, and peritoneum. Pretreatment staging of MIBC should include imaging of the urothelial upper tract for synchronous lesions; imaging of the chest, abdomen, and pelvis for metastases; and MRI pelvis for local staging. CT abdomen and pelvis without and with contrast (CT urogram) is recommended to assess the urothelium and abdominopelvic organs. Pelvic MRI can improve local bladder staging accuracy. Chest imaging is also recommended with chest radiograph usually being adequate. FDG-PET/CT may be appropriate to identify nodal and metastatic disease. Chest CT may be useful in high-risk patients and those with findings on chest radiograph. Nonurogram CT and MRI of the abdomen and pelvis are usually not appropriate, and neither is radiographic intravenous urography, Tc-99m whole body bone scan, nor bladder ultrasound for pretreatment staging of MIBC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.",
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