What is the role of imaging studies in the surveillance for recurrent bladder cancer?

Updated: Sep 10, 2019
  • Author: David A Levy, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Transitional cell carcinoma (TCC) is a field change disease, meaning that the entire field of transitional cells is prone to the DNA changes leading to cancer. Therefore, the entire urothelium should be monitored, especially in higher-risk individuals. [11]

The frequency of upper tract imaging for post-treatment surveillance is still not standardized. However, many authors recommend annual urography, especially in high-risk patients.

Patients at high risk should undergo intermittent evaluations during the surveillance period. Patients with positive urine cytology results or positive findings from FISH or other bladder tumor indicators who have no tumor identified in the bladder to explain the positive test result should undergo repeat upper tract evaluation.

Excretory urography (ie, intravenous pyelography [IVP]; now limited in availability in many institutions, having been replaced with newer CT imaging techniques), retrograde pyelography, and ureterorenoscopy can help detect upper tract synchronous or metachronous tumors. The accuracy of these tests increases in the order listed, with radiographic imaging missing up to three fourths of small upper tract tumors in some series if read by a radiologist instead of the urologist present in the operating room during retrograde contrast injection.

Office-based cystourethroscopy has a role in some patients with upper tract TCC treated with nephron-sparing surgery.

CT urography using digital reconstruction of CT images to create a view of the ureters potentially can blend the advantages of CT (ie, speed, visualization of renal parenchyma, visualization of nonurological structures) with the advantages of excretory or retrograde urography (ie, visualization of the upper tract lumen). An An increasing number of referral centers have the ability to perform this modality.

Some centers also use CT intravenous pyelography. Kidney-ureter-bladder (KUB) imaging is performed, followed by a noncontrast CT scan of the abdomen and pelvis. Contrast is then injected intravenously, followed by vascular and excretion-phase CT abdominopelvic imaging. The patient then undergoes anteroposterior and oblique abdominal radiography and postvoid radiography.

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