incidence of bladder cancer (RMP), the world tends
to the continuous growth of 1, 3. RDM takes eighth place among all
of cancer in Febasary, accounting for 10% of pathology
urologic and over 50% of pathology of the specialized onkourologicheskih
Offices 3 and 4. Feature of DMS is part of a local recurrence.
For adequate exposure to the recurrent tumor to be detected
its first signs as early as possible.
problem increasing morbidity RDM creates the need to search
opportunities for early detection of recurrence for an adequate approach
to their treatment. It is necessary to increase the duration of relapse-free
period and improve the quality of life of patients. Currently, methods
radiodiagnostics RMP serve in the first place, ahead of the sensitivity
and specificity of conventional cystoscopy. Back in 1988, Meuleman
E.J. and Delaere K.P. 14 pointed to the need to combine
the use of ultrasound (U.S.) and cystoscopy.
shown that ultrasound is the preferred method for early
diagnosis of recurrence of RMP, which are located on the top, side
walls and the lower end and having a size greater than 5 mm 5. Many
scientists have noted a high percentage of errors in the application of ultrasound as an isolated
method - up to 30% of 9, 15, while eliminating the need for endoscopic
research in general 9. Despite the emergence of new opportunities
Beam Diagnostics (computer and magntitno resonance imaging
- CT and MRI), ultrasound is conducted when it is impossible the implementation of other
procedures in the facility. Opportunities CT in detecting recurrence
in the bladder are small enough to use the method effectively
the defeat of regional lymph nodes 5, 18 or in the propagation
to adjacent organs 5, 17, when it is possible to estimate the thickness
and the density of the bladder wall 11, 12.
With the advent of MRI diagnostic capabilities RMP and its recurrence markedly
rose 10. Proved that the possibility of MRI for cancer recurrence
with signs of invasion is higher than in CT, transabdominal ultrasound and
physical examination, 6, 8, 13, 16. For small amounts of tumor
(Not applicable to the muscular layer - Tis, Ta, T1) opportunities
MRI is less and scientists recommend the use of combined approach
using morphological techniques 7. The aim of the study, performed
us, was to determine the possible application of methods of radiation
diagnosis at different stages of relapse RMP. The tasks included
assessment of specificity, sensitivity and accuracy of methods to identify
tumor stage, determine the most optimal combination of methods
and a mandatory intraoperative (final) diagnosis
RMP.
Materials and methods.
We examined 49 patients aged from 48 to 69 years (mean
Age - 59 years) all patients previously performed transurethral
resection (TUR) of bladder over with transitional cancer.
Men was 34 (69,3%), women 15 (30,7%). At admission
All patients complained of gross hematuria and dysuria. All
patients underwent pelvic CT, 46 (93,9%) patients -
Ultrasonography (transabdominal (Towse) and transrectal (TRUS)) and 23 (46.9%)
patients - MRI (of them - 9 studies with an additional contrast,
with the use of dasgs based on gadolinium - Magnevist ® »).
When the ultrasound machine was used
Ultrasound «Logiq 400 with Convex sensors 5 and 7.5 MHz transrectal
7.5-MHz transducer. When performing CT scan was used
GE 9800 (scan time 4.5 seconds, slice thickness 10 mm). Magnetic resonance
tomography was carried out using the apparatus of 1,5 Tesla (SIGNA,
General Electric Co.).
results.
RMP Recurrences were detected in 45 (91.8%) patients, as confirmed
during the subsequent surgical treatment: with 9 transurethral
resection (TUR), 24 sectoral and gemirezektsy and 12 cystectomy.
In 4 (8.2%) patients with recurrence had not been diagnosed with an additional
using endoscopic and morphological diagnostics.
Accuracy in determining relapse and stage for the individual techniques
was: 59.5% for MRI, MRI with an additional contrast
up 73,7% with the use of CT - 47,4%, while SPL - 52%. In identifying
superficial tumors method of choice is ultrasonography, the appearance of
invasive component of tumorsmorefrequently used a combination of MRI and
CT.
use of ultrasound for the location of tumors in
cervical triangle and pouring was justified: that all 29 (64,4%)
recurrence in this area have been identified in TRUS (sensitivity
up to 94%). Towse sensitivity to 53% at the location marked
formations on the side and back walls, as well as the apex
bladder. These studies using MRI and CT data for localization
weremoreaccurate (sensitivity 74.7% and 68.3%, respectively).
The expediency of CT was observed only in 8 (17.8%) cases when
there was invasion okolopuzyrnoy fiber, and no doubt in cancer recurrence
not occurred (96% sensitivity in detecting T3a-T3b-stages).
Accuracy of CT in determining the stage of relapse was found to be 66%
when used in conjunction with MRI - up to 79%.
In determining the invasive recurrences (2-3 stages)
MRI showed high precision and sensitivity (92%). Under the additional
contrasting of the bladder, held in the axial and coronal
planes managed to achieve a clear visualization of the outer wall
bladder and perivesical fat.
was used in this program, "the suppression of fat."
All this is possible to achieve accuracy in detecting recurrence in 33 (73,7%)
patients (MRI without contrast - in 59,5%).
In identifying the minimal tumor growth in the gallbladder wall in
7 (15,6%) patients admitted through 3-4,5 months after TUR of superficial
tumors were used, and morphological methods of diagnosis.
Conclusions.
use ultrasound, CT and MRI is justified in suspected recurrence of RMP,
because the methods have high sensitivity and specificity.
Difficulties have arisen in the investigation of superficial tumors and recurrences,
located in the triangle pours. In a joint application
several methods appears to significantly improve the quality of
survey and a timely treatment of recurrence.
References:
1. Aksel EM, Matveev BP Onkourologicheskoy state aid
patients in Russia, 1997-Clinical onkologiya.1999.T.1. ¹ 1.
C.3-4.
2. Kolosov AE Recurrences of malignant tumors. Kirov. 1995.
S. 176-185
3. Lopatkin NA, Martov AG, Darenkov SP, Kamalov AA etc.
Operative treatment of bladder tumors. / / Urology and Nephrology.
1999. ¹ 1. S. 26-31.
4. Nechiporenko NA, Strotsky AV "Diagnosis and treatment of locally advanced