Computerized Tomography for Detecting Perivesical Infiltration and Lymph Node Metastasis in Invasive Bladder Carcinoma
ABSTRACT 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.
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ABSTRACT: To evaluate the agreement between radiologic staging of bladder cancer using multidetector row computed tomography (CT) and histopathologic staging and estimate the influence of interobserver variability of the CT findings as a potential limitation of this imaging modality. The available data on the value of multidetector row CT in clinical staging before cystectomy are controversial. The multidetector row CT reports of all patients undergoing radical cystectomy at our institution from 2004 to 2008 were retrospectively reviewed and compared in a blinded expert review by an experienced abdominal/genitourinary radiologist. The results of both radiologic reviews were subsequently correlated with the pathologic findings of the surgical specimens. The interobserver variability of radiology reports was estimated using κ statistics. Preoperative CT scans were available for 276 patients who underwent radical cystectomy. The accuracy of the primary and reference radiologists in predicting the correct local tumor stage was 49% (κ 0.23, P < .001) and 51% (κ 0.24, P < .001), respectively. The accuracy in predicting the presence of lymph node metastases was 54% (κ 0.04, P = .297) and 58% (κ 0.15, P = .011). The agreement between both radiologists was fair with regard to the local tumor stage (κ 0.23, P < .001) and the presence of lymph node metastases (κ 0.35, P < .001). The overall agreement between the local bladder cancer stage between CT and pathologic staging was poor to fair. Significant interobserver variability was found in the CT findings that might contribute to the limited accuracy of CT in the detection of extravesical tumor spread, infiltration of extravesical organs, and lymph node involvement.Urology 03/2012; 79(6):1317-21. DOI:10.1016/j.urology.2012.01.040 · 2.13 Impact Factor
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ABSTRACT: Objective: To evaluate the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) in the detection of bladder lesions. Methods: We conducted a systematic PubMed/MEDLINE and Embase database search of articles published before November 2012. Sensitivity, specificity, likelihood ratio and diagnostic odds ratio were pooled. A summary receiver operating characteristic curve was also used to summarize overall test performance. All meta-analyses were performed using the Meta-DiSc software (version 1.4). Results: Six studies met the inclusion criteria. The pooled sensitivity and specificity of PET or PET/CT for the detection of bladder cancer was 80.0% (95% CI: 71.0-87.0%) and 84.0% (95% CI: 69.0-93.0%), respectively. The overall positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 3.47 (95% CI: 1.03-11.65), 0.31 (95% CI: 0.13-0.70) and 13.86 (95% CI: 2.84-67.74), respectively. Besides, the area (± standard error) under the symmetrical summary receiver operating characteristic curve was 0.8574 ± 0.0704. Conclusion: When compared with results of MRI and CT published by other studies, (18)F-FDG PET or PET/CT showed no superiority in detecting local bladder lesions. As a whole body imaging, it is suggested that PET is more appropriate for the detection of metastasis.Urologia Internationalis 08/2013; 92(2). DOI:10.1159/000351964 · 1.15 Impact Factor
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ABSTRACT: Objective: To elucidate the role of CXCR4 in the metastasis of bladder transitional cell carcinoma (BTCC) by examining CXCR4 expression in BTCC tissue and its correlation with clinicopathological features. Methods: The expression of CXCR4 was assessed in bladder tissues from 70 BTCC patients and 18 normal controls, respectively, using immunohistochemistry. The correlation of CXCR4 expression with lymph node metastasis was also examined by determining the lymphatic vessel density (LVD). Results: Overexpression of CXCR4 was detected in 58/70 (82.9%) BTCC tissues, whereas only in 3/18 (16.7%) normal bladder tissues. The expression was significantly higher in BTCC than that in normal controls (p < 0.01). CXCR4 expression level was closely associated with tumor size, pathological grades, clinical stages, and pelvic lymph node metastasis (p < 0.05). Multivariate analysis indicated that CXCR4 expression and lymph node metastasis were independent predictors for disease-free survival (both p < 0.05). The disease-free survival rate among the patients with high CXCR4 expression level was remarkably lower than that among the patients with no or low level expression (p < 0.01). Conclusion: Highly expressed in BTCC tissues, CXCR4 may play a critical role in the metastasis of BTCC, and the expression level in biopsy specimens might be a good indicator of lymph node metastasis.Urologia Internationalis 08/2013; 92(2). DOI:10.1159/000351952 · 1.15 Impact Factor