[New protocol for local staging in bladder carcinoma. Ultrasonographic, cytological and histopathological...

The diagnostic error using classical methods in the staging of bladder tumors has been reported to range from 20 to 50%. With the advent of new diagnostic imaging techniques (CT and MRI) the accuracy rate has increased from 62% to 83%. Forty-eight patients with bladder tumors were submitted to a protocol correlating ultrasound (US), cytological and histopathological findings. Tumor staging was also performed by CT in 10 patients and by MRI in 3. Transurethral ultrasound distinguished the superficial from the infiltrating bladder tumors in 100% of the cases. The accuracy rate for US was greater than that of CT (90% versus 70%) and MRI although the difference was not statistically significant with respect to MRI. When cold biopsy was combined with transurethral US, the correlation of overall staging (level of infiltration and degree of non-differentiation) was 85% for the superficial tumors and 82.3% for the infiltrating tumors. Furthermore, no significant difference was observed between the cytological analyses of urine from micturition or lavage. Cytologically, the number of positives increased with the degree of tumor non-differentiation. These findings show that transurethral US combined with cold biopsy permits determining the stage as well as the degree of non-differentiation of the tumor with minimum error, which is crucial in determining the approach to tumor management utilizing the new treatment protocols for bladder carcinoma.