Evaluation of the depth of infiltration of urothelial carcinoma in the vesical wall obtained by transurethral intravesical echotomography

Abstract

Background/Aim. Transitional cell carcinoma (TCC) is the most frequent tumor of the bladder and represents 95?98% of blader neoplasams and 2?3% of all carcinomas in the body. In urogenital oncology more frequent is only prostatic cancer. Evaluation of the depth of infiltration of urothelial carcinoma in the vesical wall represents the clinical base in treatment planning and prognosis. Clinical investigation and convential radiological procedures have a low level of accuracy in estimating the local growth of the tumor. The aims of our investigation were to determine the depth of infiltration of urothelial carcinoma in the vesical wall in the investigated group of patients by transurethral intravesical echotomography (TIE) and computerised tomography (CT scan) and to compare results obtained by both methods with pathohistological (PH) results, and, based on the difference of the results determine which method was more accurate in the evaluation of the depth of infiltration of urothelial carcinoma in the vesical wall. Methods. Thirty patients with TCC of the bladder both genders, aged 51?81 years were involved in our investigation. In all of these patients, radical cystectomy (RC) was performed. This was neccessary to provide the defintive PH result. Transurethral intravesical echotomography was performed by ultrasound scanner type 1846 Bruel and Kjaer, sond type 1850, and the CT scan was perfomed by Pace plus, General Electric, U.S.A. The specimen for the definitive PH result obtained by RC includes all standards of the TNM classification. Results. Using CT scan, the most frequent was T1 stage (17 patients or 56.68%). Using TIE, the most frequent was T2 stage (22 patients or 73.33%). After RC the most frequent was T2 stage (21 patients or 70%). The Kolmogorov-Smirnov test, showed a high significant difference between the results obtained using CT and definitive PH results after RC. The same test showed no statistically significant difference between the results obtained using TIE and definitive PH results. The sensitivity and accurance of TIE compared to definitive PH results was 93.3%, but using CT it was only 33.3%. Conclusion. There was a significant difference between the results obtained using CT and TIE. The results obtained by TIE were in closer relation with the definitive PH results than the results obtained by CT scan. TIE provides more precise evaluation of the depth of infiltration of urothelial carcinoma in the vesical wall than CT scan. We conclude that the use of this procedure in local staging in TCC is justified and represents the clinical basis in the treatment planning and disease outcome prognosis.