Improving clinical staging remains an unmet clinical need in muscle-invasive bladder cancer (MIBC). Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) – the standard radiological techniques to stage MIBC – are affected by accuracy limitations leading to clinical to pathologic stage discrepancy in a not negligible number of cases. The role of [18F]Fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) to evaluate pre-operative lymph node involvement (LNI) in MIBC is still under debate and a recent study reported limited utility in patients with clinically negative lymph nodes (cN0).1