MP65-03 IS EXAM UNDER ANESTHESIA STILL NECESSARY FOR THE STAGING OF BLADDER CANCER IN THE ERA OF MODERN IMAGING?

Abstract

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 2014MP65-03 IS EXAM UNDER ANESTHESIA STILL NECESSARY FOR THE STAGING OF BLADDER CANCER IN THE ERA OF MODERN IMAGING? Alexander Rozanski, Jacob A. McCoy, Cooper R. Benson, Charles Green, H. Barton Grossman, Robert Svatek, and Jay Shah Alexander RozanskiAlexander Rozanski More articles by this author , Jacob A. McCoyJacob A. McCoy More articles by this author , Cooper R. BensonCooper R. Benson More articles by this author , Charles GreenCharles Green More articles by this author , H. Barton GrossmanH. Barton Grossman More articles by this author , Robert SvatekRobert Svatek More articles by this author , and Jay ShahJay Shah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1900AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ability to accurately determine tumor stage in bladder cancer is of critical importance because it impacts the management paradigm and overall prognosis. Despite advances in modern imaging technology, there is still a discrepancy between clinical and pathological staging. Historically, exam under anesthesia (EUA) has been a useful tool to assist in the staging of bladder cancer. In this era of modern imaging technology, we sought to determine if EUA provides any additional contribution in the clinical staging of bladder cancer. METHODS The medical records of patients who were treated at MD Anderson Cancer Center and managed by one of two urologists, whose practice is focused on bladder cancer, were retrospectively reviewed. Univariate and multivariate analyses were performed and logistic regression models were generated to determine the ability of EUA, imaging, and other patient characteristics to predict pathological fat extension at the time of cystectomy. RESULTS There were 414 patients in our cystectomy database included in the analyses. 38% of the patients had ≥ pT3 disease at the time of cystectomy. We found that 31.9% of patients had findings on EUA suggestive of T3 disease, whereas 28.7% had radiologic findings suggestive of T3 disease. In the multivariate model including age, BMI, ethnicity, year of operation, neoadjuvent chemotherapy the only factors predictive of pT3 disease were EUA and imaging, which can be found in Table 1. We also observed that utilizing both EUA and imaging, compared to imaging alone, improved the accuracy of clinical staging. CONCLUSIONS Despite advances in modern imaging over the last several decades, the performance of a thorough EUA remains a critical aspect of the staging evaluation in bladder cancer. The EUA should not be omitted as it provides unique information that is not provided by imaging alone. Multivariate analysis of factors predicting pathological fat invasion at the time of radical cystectomy Odds Ratio [95% CI] p-value Age 1.02 [0.99-1.04] 0.19 Race White Referent Black 1.15 [0.37-3.59] 0.81 Hispanic/Latino 0.91 [0.34-2.42] 0.85 Asian 1.55 [0.12-20.5] 0.74 Gender Male Referent Female 1.49 [0.85-2.61] 0.17 BMI 0.85 [0.59-1.22] 0.37 Year of surgery 1.00 [0.99-1.00] 0.53 Imaging type (CT v. MRI) 0.38 [0.11-1.31] 0.13 Neoadjuvant chemotherapy 0.77 [0.46-1.28] 0.31 EUA suggestive of T3 2.22 [1.34-3.69] 0.002 Imaging suggestive of T3 2.18 [1.33-3.58] 0.002 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e692 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alexander Rozanski More articles by this author Jacob A. McCoy More articles by this author Cooper R. Benson More articles by this author Charles Green More articles by this author H. Barton Grossman More articles by this author Robert Svatek More articles by this author Jay Shah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...