The Clinical Significance of Cystoscopy and Computed Tomography in Pretrearment Evaluation of Invasive Cervical Cancer

Lee, Je Hoon; Lee, Chul Min; Kang, Young Sook; Park, Young Joon; Han, Sung Sik; Park, Gyo Hoon; Jo, Yong Gyun; Choi, Hoon; Kim, Bok Rin; Lee, Hong Gyun

Abstract

OBJECTIVE
Cystoscopy has been included as diagnostic procedure for pretreatment evaluation of cervical cancer by FIGO. However, its invasiveness brings up a question regarding the necessity of inclusion in staging work up of cervical cancer. We performed this study to evaluate the clinical implication of cystoscopy in cervical cancer staging. METHODS: 128 patients with invasive cervical cancer patients who were histologically diagnosed from Jan 1995 to Dec 1999 were retrospectively reviewed. Physical examination, computed tomography (CT), cystoscopy were performed in all patients. The distribution of FIGO stage was Ib 48.4%, II 35.2%, III 8.6%, and IV 7.8%. Bladder invasion was evaluated in CT and histopathologic examination was performed on cystoscopy when invasion was suspected. McNemar test was used to compare the finding in CT and cystoscopy for matched patients. P-value of 0.05 was regarded as statistically significant. RESULTS: Among seven patients whose bladder was suspected to be invaded by cervical cancer in CT scan, three patients had actual bladder invasion confirmed by cystoscopy (positive predictive rate = 42.9%). CT was statistically comparable to cystoscopy (P = 0.375, McNemar test; contingency coefficient = 0.481). CONCLUSION: Cystoscopy, which is an invasive procedure, may not be necessary and might be substituted by CT scan for pretreatment evaluation in some subset of cervical cancer patients.