title: Revisiting the role of computerized tomographic scan and cystoscopy for detecting bladder invasion in the revised FIGO staging system for carcinoma of the uterine cervix.
abstract: BACKGROUND
  Recent revision of the International Federation of Gynecology and Obstetrics (FIGO) staging system for the cervix encourages use of computerized tomography (CT) and magnetic resonance imaging and does not recommend cystoscopy as a mandatory investigation. But the revision has not defined which patients should undergo cystoscopy. Our study aims to revisit the role of CT scan and cystoscopy for detecting bladder invasion so that we can select patients for cystoscopy.
  
  
  METHODS
  We reviewed case records of all cervical cancer patients who underwent abdominopelvic CT scan besides standard FIGO staging workup (including cystoscopy) and treatment with radiotherapy or concurrent chemoradiotherapy between years 2003 and 2005. Patients showing bladder invasion on CT scan or cystoscopy were identified and separately analyzed. Considering cystoscopy as the standard reference investigation, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CT scan for bladder invasion were calculated.
  
  
  RESULTS
  A total of 305 case records were analyzed. Median age of the patients was 50 years (range, 25-85 years). Forty-three (14%) patients had bladder invasion on CT scan, and 17 (5.5%) had cystoscopy-confirmed invasion. No patient showing absence of bladder invasion on CT scan showed cystoscopy-confirmed invasion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CT scan for bladder invasion were 100%, 92%, 40%, 100%, and 92%, respectively. The median overall survival of patients with CT-detected bladder invasion versus cystoscopy-confirmed invasion was 13 months versus 4 months, respectively (P = 0.007).
  
  
  CONCLUSIONS
  Our results show that for cervical cancer, cystoscopy is not required in patients without any bladder invasion on CT scan. In the revised FIGO staging system, use of cystoscopy may be limited to patients having suspicious bladder invasion on CT scan. This will benefit both patient population and gynecologic oncologists, especially in developing countries with limited resources.
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. sharmadn@hotmail.com
authors.forename: Daya Nand
authors.initials: DN
authors.lastname: Sharma
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.forename: Shikha
authors.initials: S
authors.lastname: Goyal
authors.forename: Nootan Kumar
authors.initials: NK
authors.lastname: Shukla
authors.forename: Sunesh
authors.initials: S
authors.lastname: Kumar
authors.forename: Goura Kisor
authors.initials: GK
authors.lastname: Rath
authors.forename: Parmod Kumar
authors.initials: PK
authors.lastname: Julka
authors.forename: Gagan
authors.initials: G
authors.lastname: Saini
authors.forename: Amit
authors.initials: A
authors.lastname: Bahl
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy