Baltaci Sumer, Resorlu Berkan, Yagci Cemil, Turkolmez Kadir, Gogus Cagatay, Beduk Yasar
Department of Urology, Faculty of Medicine, University of Ankara, Ankara, Turkey.
Urol Int. 2008;81(4):399-402. doi: 10.1159/000167836. Epub 2008 Dec 10.
Computerized tomography (CT) is used in the preoperative staging of invasive bladder carcinoma. We evaluated the role of CT for detecting perivesical invasion and lymph node metastases in patients who had undergone radical cystectomy and pelvic lymphadenectomy for invasive bladder carcinoma.
We retrospectively analyzed the clinical and pathological data of 100 patients with invasive bladder carcinoma who had undergone radical cystectomy. The preoperative CT images were reevaluated and interpreted by one uroradiologist blinded to the final pathological results for evidence of extravesical tumor extension or lymph node metastases.
Of the 100 patients, CT showed extravesical tumor involvement in 57. Of these 57 cases, 22 displayed no evidence of extravesical tumor involvement in the final pathological analysis. In 6 cases, although perivesical invasion was identified in the final pathological analysis, preoperative CT showed no evidence of extravesical tumor involvement. Regarding extravesical tumor spread, the differences between CT and pathological stages were statistically significant (p < 0.001). CT was highly suggestive of lymph node metastases in 9 cases, but only 4 were pathologically confirmed. On the other hand, in 9 patients pelvic lymph node metastasis were pathologically diagnosed, but there was no evidence of lymphadenopathy on CT. Regarding lymph node involvement, there was moderate concordance between CT and pathological findings (p = 0.003, kappa = 0.29 +/- 0.14).
CT has limited accuracy in detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma. The information provided by CT is insufficient and we urgently need more reliable staging techniques.
计算机断层扫描（CT）用于浸润性膀胱癌的术前分期。我们评估了CT在接受浸润性膀胱癌根治性膀胱切除术和盆腔淋巴结清扫术患者中检测膀胱周围浸润和淋巴结转移的作用。
我们回顾性分析了100例行根治性膀胱切除术的浸润性膀胱癌患者的临床和病理数据。术前CT图像由一位对最终病理结果不知情的泌尿放射科医生重新评估和解读，以寻找膀胱外肿瘤扩展或淋巴结转移的证据。
100例患者中，CT显示57例有膀胱外肿瘤累及。在这57例中，最终病理分析有22例未显示膀胱外肿瘤累及的证据。6例患者在最终病理分析中虽发现膀胱周围浸润，但术前CT未显示膀胱外肿瘤累及的证据。关于膀胱外肿瘤扩散，CT与病理分期之间的差异具有统计学意义（p < 0.001）。CT高度提示9例有淋巴结转移，但只有4例经病理证实。另一方面，9例患者经病理诊断有盆腔淋巴结转移，但CT上没有淋巴结肿大的证据。关于淋巴结受累情况，CT与病理结果之间存在中度一致性（p = 0.003，kappa = 0.29 +/- 0.14）。
CT在检测浸润性膀胱癌的膀胱周围浸润和淋巴结转移方面准确性有限。CT提供的信息不足，我们迫切需要更可靠的分期技术。
