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A New Parameter for Staging Bladder Carcinoma

Ultrasonographic Contact Length and Height-to-Length Ratio

Eriz Özden, MD, Ahmet Tuncay Turgut, MD, Mesut Yeil, MD, Çaatay Göü, MD and Orhan Göü, MD

Department of Urology, Ankara University School of Medicine, Ankara, Turkey (E.Ö., M.Y., Ç.G.); Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey (A.T.T.); and Department of Urology, Ufuk University School of Medicine, Ankara, Turkey (O.G.).

Address correspondence to Eriz Özden, MD, Ankara Üniversitesi Tip Fakültesi Ibni Sina Hastanesi, 06100 Ankara, Turkey. E-mail: erizozden{at}yahoo.com

Objective. The purpose of this study was to investigate the value of tumor-bladder wall contact length (CL), tumor height (H), and height-to-length ratio (H/CL) for preoperative staging of bladder carcinoma. Methods. Fifty-seven patients with bladder tumors underwent suprapubic ultrasonography preoperatively, and the CL of the tumor with the bladder wall and H in the bladder lumen were measured. The CL, H, and H/CL values were correlated with the wall invasion determined by histopathologic analysis of the cystectomy material. Invasion was staged according to the TNM classification system. Results. Statistically significant differences were found for CL (P < .001) and H/CL (P = .001) between the superficial and invasive tumor groups. These parameters were also effective for differentiating superficial or deep muscle invasion. A CL of greater than 41.5 mm and an H/CL of less than 0.605 were calculated as cutoff values for differentiating superficial and invasive tumors. Height had no value for determining invasion. Conclusions. The ultrasonographic measurements of CL of the tumor with the bladder wall and H/CL may be useful for staging bladder carcinoma by verification of these findings in larger groups of patients.

Key Words: bladder tumors • ultrasonography • urinary bladder carcinoma

Abbreviations: CL, contact length • CT, computed tomography • H, tumor height • H/CL, height-to-length ratio • MRI, magnetic resonance imaging • ROC, receiver operating characteristic • TUR, transurethral resection • TUUS, transurethral ultrasonography