ROLE OF CT SCAN IN STAGING OF CA URINARY BLADDER WITH HPE CORRELATION

Introduction: Of every 10,000 people every 2 to 3 person will develop urinary bladder cancer. Direct examination via endoscopy remains the investigation of choice for evaluation of superficial urinary bladder lesions and the evaluation of deeper structures requires USG, CT or MRI. The goal of imaging is to define extent of tumour spread, nodal and distant metastasis. Objectives: To evaluate the role of computed tomography (CT) for staging of carcinoma urinary bladder. Methodology: 55 patients were selected for the study for which they underwent computed tomography (CT) examination after explaining the entire procedure and the risks involved. Results: In our study, urinary bladder cancer was most common in 51-60 years age with more common in males compared to females with ratio of 5.1:1. Most common HPE subtype is transitional cell carcinoma (82%) followed by squamous cell carcinoma (8%) and adenocarcinoma (6%). Most of urinary bladder carcinoma arises from lateral wall (51.4%) followed by base of urinary bladder (16.2%). On CT, 16 (29.09%) patient diagnosed as Stage II disease, 13 (23.64%) as Stage III disease and 26 (47.27%) patient diagnosed as Stage IV disease with sensitivity - 85.71%, specificity - 44.44%, PPV - 37.5% and NPV- 88.88% for stage II and Sensitivity - 83.33%, specificity - 83.33%, PPV - 38.46% and NPV- 93.75% for stage III disease respectively. HPE staging shows 12 (21.82%) as Stage I, 7(12.73%) as Stage II, 6(10.91%) as Stage III and 26 (47.27%) as Stage IV disease. Total 26 out of 55 patients showed metastatic spread from which nodal metastasis is most common (80.77%) followed by liver (26.92%), lung and bone metastasis (11.54%). Conclusion: CT plays an important complementary role to clinical examination and endoscopic biopsy in detection, localization, characterization and pre therapeutic staging of urinary bladder masses as delayed scanning allows excellent depiction of the luminal anatomy of urinary bladder and is also very sensitive to assess associated nodal disease (N staging) and systemic metastases (M staging).