Role Of Ultrasound Diagnosis Of Cancer Urinary Bladder:

Medhat Mohamed Saber El-sherbiny

Ultrasonographic diagnosis of urinary bladder carcinomacan be subdivided into two problems : 1- Tumour detection(including the differential diagnosis), and 11- Tumour.taging. Exophytic bladder carcinomas appear as intraluminalpolypoidal filling defects projecting from the echogenicbladder wall into the anechoic bladder lumen. They arehypoechoic compared to the echogenic bladder wall and do notalter their location on changing patient position. Largertumours have complex architecture due to haemorrhage andnecrosis. Superficial non-infiltrating tumours give animpression of mucosal irregularities without distortion orfixation of the bladder wall with sharp demarcation betweenthe tumour and the adjacent normal mucosa. ~hey have welldefined base. Infiltrating tumours cause disrruption of theechogenic bladder wall beneath the tumour with dimenution ofthe bladder capacity. The tend to have broader base.Extravesical extension shows features of infitrative tumoureand in addition irregular masses are present in thesurrounding pelvic,tissues.Concering the ultrasonographic staging of urinary bladdercarcinoma both Jewett-Strong-Marshal and TNlolclassificationsare used. The ultrasonographic findings based on rigidity andcontinuity of the bladder wall as well as the reduction of the147. ----bladder capacity. More recently, the degree of tumouriniltration into the bladder wall is exposed under variouslevels of amplifier gain. Accordingly, ladder tumours can becla.sified as follow:- Superficial tumours (Ta - ’1’1):the echOOense bladder wallunderlying the less echogenic tumour appear smooth anduninterrupted without deformity or reduction of the bladdercapacity.- Tumours infiltrating the bladder wall (’1’2 - T3a) : theechodense bladder wall is interrupted without deformity orreduction of the bladder capacity.- Tumours extending beyond the bladder wall· (T3b - ’1’4):theperivesical tissue is involved by the hypoechoic tumour tissuewith deformity of the wall and reduction of the bladdercapacity. The perivesical structures may be involved.The internal iliac lymph nodes are the most common sitesof metastases. Pelvic lymphadenopathy are often detected bytransabdominal approach. The main role of transuretheralscanning is useful in evaluatingthe primary tumour and tomonitor the depth of transuretheral resection of a bladdertumour. Transrectal and transuretheral scanning can offerinformations concerning the conditions of the baldder wall e.gdetecting the degree of tumour infiltration.An overall accuracy of only 62 in evaluating bladdertumours by ultrasound. This accuracy rate is related to thesize and location of the tumour. The detection accuracy fortWllOurs less than 5 IDDI in diameter was as low as 33.3compared to 83.3% for those between 1-2 cm and 95% for thosemore than 2 cm diameter. A low accuracy rate was observed fortumours located in bladder neck and dome in contrast to thoselocated on the posterior and lateral walls.