Matthew Donald Fernand McInnes MD, FRCPC, Presenter: Nothing to Disclose

David Robert Siemens, Abstract Co-Author: Nothing to Disclose

William Mackillop MD, Abstract Co-Author: Nothing to Disclose

Yingwei Peng PhD, Abstract Co-Author: Nothing to Disclose

Shelly Wei, Abstract Co-Author: Nothing to Disclose

Nicola Schieda MD, Abstract Co-Author: Nothing to Disclose

Christopher M. Booth MD, FRCPC, Abstract Co-Author: Nothing to Disclose

To describe the use of pre-operative imaging for muscle-invasive bladder cancer and to evaluate the association between imaging and patient outcome in routine clinical practice.

In this IRB-approved, population-based cohort study, electronic records of treatment were linked to the Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy in Ontario from 1994-2008. Utilization of various chest, abdomen, pelvis and bone imaging strategies was evaluated over time. Temporal trends were evaluated over 3 study periods (1994-1998, 1999-2003, and 2004-2008). Logistic regression was used to analyze factors associated with imaging utilization. Cox model analyses were used to explore associations between imaging and survival.

2802 patients with MIBC underwent cystectomy during 1994-2008. Utilization increased over the 3 study periods: chest x-ray (CXR) (55%, 64%, 63%, p<0.001), CT chest (10%, 10%, 21%, p<0.001), bone scan (30%, 34%, 36%, p=0.04) and CT, US or MR of the abdomen and pelvis (85%, 90%, 92%, p=<0.001). Use of chest and bone imaging was independently associated with age, N-stage, surgeon cystectomy volume, and geographic region. In adjusted analyses we found inferior outcomes among patients who did not have pre-operative chest imaging (CXR or CT): Overall survival (OS) hazard ratio (HR) 1.12 (95%CI 1.01-1.25), cancer specific survival (CSS) HR 1.09 (0.97-1.22); or bone scan OS HR 1.11 (1.01-1.22), CSS HR 1.09 (95%CI 1.01-1.25). No benefit for CT chest over CXR was identified.

In routine clinical practice, there is considerable variation in use of pre-operative chest, body, and bone imaging. Pre-operative chest and bone imaging is associated with improved outcomes. No survival benefit for CT chest over CXR was identified.  This association likely reflects better patient selection for cystectomy.

Pre-operative chest and bone imaging to stage muscle-invasive bladder cancer is associated with improved outcomes. This association likely reflects better patient selection for cystectomy.

McInnes, M, Siemens, D, Mackillop, W, Peng, Y, Wei, S, Schieda, N, Booth, C, Utilization of Pre-operative Imaging for Muscle Invasive Bladder Cancer: A Population-based Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010501.html