[Role of endovesical echography in the assessment of bladder neoplasms]

The correct assessment of T (depth of infiltration of bladder wall by cancer) is relevant to plan therapy. In fact, besides staging the local lesion, this can predict pelvic and lumboaortic lymphnode involvement (N parameter) statistically. At the INRCA Hospital in Florence, from January 1987 to December 1989, transurethral US was performed on 66 patients affected with bladder carcinomas, in order to assess the value of this diagnostic method; in all patients pathologic staging on surgical specimens from TUR (63 cases) and cystectomy (3 cases) was performed. Follow-up lasted 24 months at least. When comparing US staging (according to Holm classification) to postoperative histopathologic findings, our results showed that US tends to overstage the lesions, while no understaged tumors were seen in our series. Diagnostic accuracy was 70%. It must be pointed out that TRUS demonstrated hidden submucosal tumors in two patients previously treated with intravesical chemotherapy. Retrospectively, we were able to detect causes of error in cancer staging in some cases--i.e., large carcinomas, calcifications on tumors, radiotherapy scars, bladder wall inflammation due to intravesical BCG therapy. Moreover, some lesions which appeared to have been overstaged with TRUS and which had been treated according to histopathologic findings from TUR exhibited recurrence or disease progression. This was probably due to incomplete TUR and to the presence of residual tumor in the bladder wall.