Advertisement

Abdominal Imaging

, Volume 38, Issue 6, pp 1415–1421 | Cite as

Surveillance of patients with bladder cancer following cystectomy: yield of CT urography

  • Atul B. Shinagare
  • Cheryl A. Sadow
  • Stuart G. Silverman
Article

Abstract

Purpose

To determine the yield of CT urography (CTU) in the surveillance of patients with bladder cancer following cystectomy.

Materials and methods

In this IRB-approved, HIPAA-compliant, retrospective study of 5,404 CT urograms performed at our institution between March 2000 and February 2011, 225 CT urograms were performed in 105 patients [79 men, 26 women; mean age 65 years (43–85)] following cystectomy for bladder cancer. Median follow-up after cystectomy was 63 months (range 1–234), median time between cystectomy and CTU was 39 months (range 0–229), median follow-up after CTU was 34 months (range 1–111). CTU examinations were reviewed by two radiologists in consensus and findings were categorized into those related to surgery, locoregional recurrence, metastases, or metachronous upper tract urothelial tumor (UTT).

Findings

Findings were present in 69 (65.7 %) of 105 patients, including findings related to surgery in 60 (57.1 %) patients, locoregional recurrence or metastatic disease in 21 (20 %) patients, and UTT in 3 (2.9 %) patients. Of surgery-related findings, hydronephrosis (23/105, 21.9 %) and parastomal hernia (17/105, 16.2 %) were the most common findings. Visceral metastases (16/105, 15.2 %) and lymph node metastases (13/105, 12.4 %) were the most common manifestations of recurrent disease.

Conclusion

CTU findings in the surveillance of patients with bladder cancer after cystectomy are common and include those related to surgery, spread of the disease, and metachronous tumors. Our study supports current published guidelines on the use of CTU in these patients.

Keywords

Bladder cancer Surveillance Follow-up CT urography Yield 

Notes

Conflict of interest

None.

References

  1. 1.
    Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. CA Cancer J Clin 63(1):11–30PubMedCrossRefGoogle Scholar
  2. 2.
    Stenzl A, Cowan NC, De Santis M, et al. (2009) The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 55:815–825PubMedCrossRefGoogle Scholar
  3. 3.
    Bellmunt J, Guix M (2010) New agents for bladder cancer. Ann Oncol 21(Suppl 7):vii56–vii58PubMedCrossRefGoogle Scholar
  4. 4.
    Vrooman OPJ, Witjes JA (2010) Follow-up of patients after curative bladder cancer treatment: guidelines vs. practice. Curr Opin Urol 20:437–442PubMedCrossRefGoogle Scholar
  5. 5.
    Shariat SF, Karakiewicz PI, Palapattu GS, et al. (2006) Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 176:2414–2422 (discussion 2422)PubMedCrossRefGoogle Scholar
  6. 6.
    Stein JP, Lieskovsky G, Cote R, et al. (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666–675PubMedGoogle Scholar
  7. 7.
    El-Nahas AR, Shokeir AA (2010) Endourological treatment of nonmalignant upper urinary. Tract complications after urinary diversion. Urology 76:1302–1308PubMedCrossRefGoogle Scholar
  8. 8.
    Catalá V, Solà M, Samaniego J, et al. (2009) CT findings in urinary diversion after radical cystectomy: postsurgical anatomy and complications. Radiographics 29:461–476PubMedCrossRefGoogle Scholar
  9. 9.
    Malkowicz SB, van Poppel H, Mickisch G, et al. (2007) Muscle-invasive urothelial carcinoma of the bladder. Urology 69:3–16PubMedCrossRefGoogle Scholar
  10. 10.
    Volkmer BG, Kuefer R, Bartsch GC, Gust K, Hautmann RE (2009) Oncological followup after radical cystectomy for bladder cancer—is there any benefit? J Urol 181:1587–1593 ((discussion 1593))PubMedCrossRefGoogle Scholar
  11. 11.
    von der Maase H, Sengelov L, Roberts JT, et al. (2005) Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 23:4602–4608PubMedCrossRefGoogle Scholar
  12. 12.
    Höglund M (2007) On the origin of syn- and metachronous urothelial carcinomas. Eur Urol 51:1185–1193 ((discussion 1193))PubMedCrossRefGoogle Scholar
  13. 13.
    Tran W, Serio AM, Raj GV, et al. (2008) Longitudinal risk of upper tract recurrence following radical cystectomy for urothelial cancer and the potential implications for long-term surveillance. J Urol 179:96–100PubMedCrossRefGoogle Scholar
  14. 14.
    Picozzi S, Ricci C, Gaeta M, et al. (2012) Upper urinary tract recurrence following radical cystectomy for bladder cancer: a meta-analysis on 13,185 patients. J Urol 188:2046–2054PubMedCrossRefGoogle Scholar
  15. 15.
    Sanderson KM, Cai J, Miranda G, Skinner DG, Stein JP (2007) Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1,069 patients with 10-year followup. J Urol 177:2088–2094PubMedCrossRefGoogle Scholar
  16. 16.
    Umbreit EC, Crispen PL, Shimko MS, et al. (2010) Multifactorial, site-specific recurrence model after radical cystectomy for urothelial carcinoma. Cancer 116:3399–3407PubMedCrossRefGoogle Scholar
  17. 17.
    Sanderson KM, Rouprêt M (2007) 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 100:11–16PubMedCrossRefGoogle Scholar
  18. 18.
    Lee EK, Dickstein RJ, Kamta AM (2011) Imaging of urothelial cancers: what the urologist needs to know. AJR Am J Roentgenol 196:1249–1254PubMedCrossRefGoogle Scholar
  19. 19.
    ACR appropriateness criteria for follow-up of patients with urothelial cancer. [Internet]. http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/FollowUpImagingBladderCarcinoma.pdf. Accessed 8 Feb 2013
  20. 20.
    Silverman SG, Akbar SA, Mortele KJ, et al. (2006) Multi-detector row CT urography of normal urinary collecting system: furosemide versus saline as adjunct to contrast medium. Radiology 240:749–755PubMedCrossRefGoogle Scholar
  21. 21.
    Sudakoff GS, Guralnick M, Langenstroer P, et al. (2005) CT urography of urinary diversions with enhanced CT digital radiography: preliminary experience. AJR Am J Roentgenol 184:131–138PubMedCrossRefGoogle Scholar
  22. 22.
    NCCN clinical practice guidelines in oncology [Internet]. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 8 Feb 2013
  23. 23.
    Bochner BH, Montie JE, Lee CT (2003) Follow-up strategies and management of recurrence in urologic oncology bladder cancer: invasive bladder cancer. Urol Clin North Am 30:777–789PubMedCrossRefGoogle Scholar
  24. 24.
    Slaton JW, Swanson DA, Grossman HB, Dinney CP (1999) A stage specific approach to tumor surveillance after radical cystectomy for transitional cell carcinoma of the bladder. J Urol 162:710–714PubMedCrossRefGoogle Scholar
  25. 25.
    Giannarini G, Kessler TM, Thoeny HC, et al. (2010) Do patients benefit from routine follow-up to detect recurrences after radical cystectomy and ileal orthotopic bladder substitution? Eur Urol 58:486–494PubMedCrossRefGoogle Scholar
  26. 26.
    Colombo R (2010) Invasive bladder cancer and the role of follow-up: should we consider the match over at radical cystectomy or should we play for extra time? Eur Urol 58:495–497PubMedCrossRefGoogle Scholar
  27. 27.
    Millán-Rodríguez F, Chéchile-Toniolo G, Salvador-Bayarri J, Huguet-Pérez J, Vicente-Rodríguez J (2000) Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol 164:1183–1187PubMedCrossRefGoogle Scholar
  28. 28.
    Wang P, Luo JD, Wu WF, et al. (2007) Multiple factor analysis of metachronous upper urinary tract transitional cell carcinoma after radical cystectomy. Braz J Med Biol Res 40:979–984PubMedCrossRefGoogle Scholar
  29. 29.
    Novara G, De Marco V, Dalpiaz O, et al. (2009) Independent predictors of contralateral metachronous upper urinary tract transitional cell carcinoma after nephroureterectomy: multi-institutional dataset from three European centers. Int J Urol 16:187–191PubMedCrossRefGoogle Scholar
  30. 30.
    Sadow CA, Wheeler SC, Kim J, Ohno-Machado L, Silverman SG (2010) Positive predictive value of CT urography in the evaluation of upper tract urothelial cancer. Am J Roentgenol 195:W337–W343CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Atul B. Shinagare
    • 1
  • Cheryl A. Sadow
    • 1
  • Stuart G. Silverman
    • 1
  1. 1.Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations