Local staging of bladder carcinoma

number: 
803
إنجليزية
department: 
Degree: 
Imprint: 
Medicine
Author: 
Adel Hamoodi Al-Qaysi
Supervisor: 
Dr. Raji H..Al-Hadithi
Dr.Riyadh A. S. Fadhil
year: 
2002
Abstract:

Urinary bladder carcinomas are the most common malignant tumors of the lower urinary tract. Accurate preoperative staging is the most important factor in determining the most appropriate management of bladder carcinoma, as the therapeutic method chosen depends on the clinical stage. Clinical staging is often inaccurate, and understaging is common (Richie JP, et al, 1992). Error rates of up to 50% have been reported for staging of invasive cancer (Skinner DB, et al, 1982). Imaging modalities such as computed tomography (CT), ultrasound and conventional magnetic resonance image (MRI) are very helpful in the investigation and diagnosis, but often fail in local tumor staging. Over the past decade, MRI with an endorectal surface coil has been described in two papers to improve the accuracy of staging of bladder carcinoma. Aim of study: In the present prospective study, we investigated the sensitivity, specificity and accuracy of an endorectal MRI with modified examination technique, sequences, and image analysis criteria in local staging of bladder carcinoma, correlated with the post-operative histopathological staging, grading and other pathological parameters. Also estimation of the p53 and laminin expression, and the trace elements level in serum, saliva and urine had been performed and correlated with the prementioned pathological parameters. Patients and Methods: The study included 53 patients with proven bladder carcinoma (45 men and 8 women, mean age 62.2 years, range 29-78 year). An endorectal MRI had been performed for all the patients and immunohistochemical study of p53 and laminin and estimation of the trace elements in the serum, saliva and urine of the patients had been performed. All of the patients underwent total cystectomy. Results and Discussion: Forty-nine cases (92.45%) were TCC and 4 cases (7.55%) were SCC. Twelve cases (22.64%) were stage T2b tumors, 1 case (1.9%) was stage T3a and 40 cases (75.47%) were stage T3b tumors. MRI understaged one case of T2b as 2a, and understaged one case of T3a as 2b. The cause was the inability of MRI to detect micro-invasion. For stage 2b the sensitivity of the MRT for staging was 92.3%, the specificity was (100%), Positive predictive value (P.P.V) was (92.3%) and the negative predictive value (N.P.V) was (97.3%). For stage 3b the sensitivity was (100%), specificity (100%), P.P.V (100%) & N.P.V (100%). The overall Accuracy was (98%). The main limitations of the current technique are the mild invasiveness & intolerance by some patients, especially old ones, and the inability of endorectal MRI in the estimation of the definite extent of extravesical extension and adjacent organs invasion by the tumor, lymph node involvement and the distant metastases. P53 overexpression seen in 23 patients, 20 males (87%) and 3 females (13%). Five patients (21.7%) were with stage 2 and 18 cases (78.3%) were stage 3. Eight patients (34.8%) were grade 2 and 15 cases (65.2%) were grade 3. No significant statistical correlation could be elicited between p53 positivity and sex of the patients, type and stage of the tumor, while a statistically significant correlation could be found with the smoking habit of the patients and grading of the tumor. The serum and salivary levels of the trace elements (Se, Zn, Fe, Mg, Mn, Co, Cd, Cr and Ni) were below normal in comparison with the levels of the subjects in the control group, except Cu level and the Cu/Zn ratio, which were increased in our study patients. Many factors have been suggested to be the contributing factors of these changes and discussed in details. Conclusion and recommendations: Endorectal MRI is a very sensitive and promising technique in local staging of bladder carcinoma. P53 is well-correlated with the grade of the tumor and laminin staining is very well- correlated with basement membrane invasion. Measurement of trace elements showed that Cu level and Cu/Zn ratio are helpful diagnostic markers but no definite correlation could be found between the levels of trace elements and the type, grade and stage of bladder carcinoma. Further detailed studies on the role of endorectal MRI in superficial bladder tumors, the role of tumor markers and trace elements in bladder carcinoma were recommended.