膀胱移行细胞癌术前CT与病理分期对照分析

The correlation of CT and pathologic staging in carcinoma of urinary bladder

目的:探讨膀胱移行细胞癌术前CT分期和术后病理分期诊断的错误原因及改正方法。方法:50例经手术、病理证实的膀胱移行细胞癌患者均行CT平扫和增强扫描。按TNM法分期。结果:术前CT分期结果押T1期13例,T2期17例,T3a期7例,T3b期5例,T4期6例,漏诊1例,无法评估1例。手术及病理分期结果:P1期16例,P2a期22例,P2b期5例,P3期2例,P4期5例。CT分期与病理符合者34例。16例CT分期与病理分期不相符合,其中分期过低者(CT分期低于病理分期)1例;漏诊1例;1例CT不能分期诊断;分期过高者(CT分期高于病理分期)13例。CT分期诊断准确率为82%(41蛐50)。病理分期诊断准确率为86%(43蛐50)。结论:CT对T3b期和T4期膀胱癌的分期诊断准确。膀胱癌临床分期需在病理诊断的基础上,充分结合CT等影像资料,综合判断以提高分期诊断的准确率。

Objective: To explore the error in CT and pathologic staging in carcinoma of urinary bladder and the method for correction. Methods: Based on the CT findings of 50 patients, primary bladder cancers were classified into 4 types according to TNM parameter. All cases were confirmed histologically. CT staging was compared with pathologic results. Results: CT staging included stage T1 13 cases,stage T2 17 cases,stage T3a 7 cases,stage T3b 5 cases,stage T4 6 cases. In addition, the tumor was missed in 1 case and in 1 case its stage could not be decided. The operation and pathologic staging including stage P1 16 cases,stage P2a 22 cases,stage P2b 5 cases,stage P3 2 cases,stage P4 5 cases. In 16 cases there were difference between CT staging and pathologic staging, in 1 case CT staging lower than pathology, in 2 cases CT failed to stage, 13 cases were over-stage. The accuracy of CT staging was 82%(41/50). The accuracy of pathologic staging was 86%(43/50). Conclusion: CT could diagnose T3b and T4 bladder cancers correctly. Based on pathology, the clinical staging of bladder cancers should combine CT to promote the accuracy of staging.