Chung H, Ahn H S, Kim Y S, Lee E J, Ryu H S, Chang K H, Kim S J
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Yonsei Med J. 2001 Oct;42(5):527-31. doi: 10.3349/ymj.2001.42.5.527.
The clinical staging system for cervical carcinoma presently recommended by the International Federation of Gynecology and Obstetrics (FIGO) does not include MRI or CT findings and thus suffers limited accuracy. Recently however, the positive contributions of MRI and CT to preoperative staging have been reported. This study involves a determination of the value of routine cystoscopy and intravenous urography, in the detection of bladder invasion or hydronephrosis resulting from cervical carcinoma, among patients who had undergone MRI or CT. Among a total 296 patients with cervical carcinoma, 271 patients (92%) had undergone MRI and 25 (8%) CT. Bladder invasion was identified pathologically by cystoscopic biopsy in 8 (57%) of the 14 patients with suspected bladder invasion on MRI or CT. There was no bladder invasion in any of the other cases lacking in bladder invasion evidence on MRI or CT. Hydronephrosis was identified by intravenous urography in 18 patients, as it also was in all of these cases on MRI or CT, confirming a negative predictive value for MRI or CT, in detecting bladder invasion or hydronephrosis from cervical carcinoma, of 100%. Therefore, although MRI or CT cannot totally replace cystoscopy, the latter is unnecessary in the absence of bladder invasion evidence on MRI or CT. Intravenous urography, however, can be safely omitted whenever MRI or CT is performed.
国际妇产科联合会（FIGO）目前推荐的宫颈癌临床分期系统未纳入MRI或CT检查结果，因此准确性有限。然而，最近有报道称MRI和CT对术前分期有积极作用。本研究旨在确定在已接受MRI或CT检查的宫颈癌患者中，常规膀胱镜检查和静脉肾盂造影在检测宫颈癌所致膀胱侵犯或肾积水方面的价值。在总共296例宫颈癌患者中，271例（92%）接受了MRI检查，25例（8%）接受了CT检查。在MRI或CT提示疑似膀胱侵犯的14例患者中，8例（57%）经膀胱镜活检病理确诊有膀胱侵犯。在MRI或CT未显示膀胱侵犯证据的其他病例中，均未发现膀胱侵犯。静脉肾盂造影发现18例患者有肾积水，MRI或CT对所有这些病例也均有显示，证实MRI或CT在检测宫颈癌所致膀胱侵犯或肾积水方面的阴性预测值为100%。因此，虽然MRI或CT不能完全取代膀胱镜检查，但在MRI或CT未显示膀胱侵犯证据时，后者并非必要。然而，只要进行了MRI或CT检查，静脉肾盂造影就可以安全地省略。
