Routine CT scan in cystectomy patients: Does it change management?

Objectives. To evaluate the practical use of a routine computed tomography (CT) scan in changing management of patients with muscle-invasive bladder cancer who are candidates for cystectomy. Methods. One hundred five patients (52 with tumors confined to the bladder and 53 with extravesical spread) were evaluated for cystectomy. The presence of nodal metastasis at surgery or biopsy was correlated with preoperative CT findings. Results. The CT scan was abnormal (nodes > 1.5 cm in size) in 32% and normal (nodes < 1.5 cm) in 68% of 28 patients with positive nodes. Of 52 cases with T2 tumors, CT scan was abnormal in 6, 14% (1 of 7) with positive and 11% (5 of 45) with negative nodes, whereas of 53 with T3-4 tumors, 15 had abnormal scans, 38% (8 of 21) with positive and 22% (7 of 32) with negative nodes. CT scan changed management (a biopsy-deferred surgery) in 2 (2%) of the 105 cases. Conclusions. A routine CT scan was not helpful in management of operable T2 tumors but might change therapy in selected patients with T3-4 tumors who are considered for cystectomy.