Introduction:
The South West Strategic Clinical Network guidelines for bladder cancer recommend CT chest/abdomen/pelvis staging for all high risk non muscle invasive bladder cancer (NMIBC) patients at diagnosis to assess for metastatic spread of the disease. This study reviewed the CT thorax diagnosis rate for metastatic disease from patients with high risk NMIBC, to assess if this is a necessary investigation.
Methods:
A retrospective review was performed from our database of all of the patients with biopsy confirmed high risk non muscle invasive bladder cancer (NMIBC) over the past year. Patients who had an initial CT thorax were assessed. Patients who did not have an initial CT thorax were also reviewed for any further chest imaging due to symptoms or progression of the disease.
Results:
There were n = 233 patients identified that had high risk NMIBC. Of the patients identified, n = 114 (49%) patients had a CT thorax at diagnosis, n = 111 had a CT thorax which was normal, n = 3 had positive finding on CT, 1 with metastasis, and 2 with benign nodules. No CT was requested at diagnosis in n = 119 (51%), only one patient had a chest radiograph due to symptoms of chronic cough and sputum during the review period, which showed no malignancy.
Conclusions:
Only one of the patients with high risk NMIBC disease had CT confirmed chest metastasis. Our findings indicate that a CT chest could be safely avoided in most high risk NMIBC patients, leading to less radiation exposure, appropriate use of radiology resources and reduced costs to the Trust.
Recommendations:
CT thorax should only be performed on patients with muscle invasive bladder cancer (≥T2), as per NICE guidelines.
