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EVALUATION OF ROLE OF DIFFUSION WEIGHTED SEQUENCE IN (T) STAGING AND GRADING OF URINARY BLADDER CANCERS KEEPING THE CYSTOSCOPIC BIOPSY AS THE GOLD STANDARD

Hira Asghar, Awais Hassan Shah, Muhammad Mubeen Ul Haq, Asad Aziz, Saira Ahmed, Sana Naseer

INTRODUCTION: Bladder cancer is the ninth most common cancer in the world with the highest recurrence rate of all malignancies. Cystoscopy, cytology and biopsy are the main diagnostic tests. Many recent studies have found that diffusion weighted imaging (DWI) on MRI can be a useful test in assessing the severity of bladder cancer with significantly strong compliance with the histopathological diagnosis of cystoscopic biopsy. Therefore, DWI can be used for preoperative diagnosis of cancer stage, and therefore can help in the proper planning of treatment. Although controversy has emerged in current literature, this study did not require publication at local level. OBJECTIVE: The objective of this study was to evaluate the degree of agreement between DW1 and histopathology for ‘T’ staging of urinary bladder cancers. MATERIAL AND METHODS: This cross sectional study was conducted at CMH Lahore from July 2018 to July 2019; included 100 patients aged 20 to 70 years diagnosed with bladder cancer. DWI MR was made for T-Staging. Histopathology of cystoscopic biopsy has been recognized as the gold standard. " RESULTS: The age of the patients ranged from 35 to 70 years, and the average was 57.56 ± 9.79 years. The study group included 82 (82.0%) men and 18 (18.0%) women. The male to female ratio was 4.6: 1. ADC values ranged from 0.60 × 10–3 mm2 / s to 1.50 × 10–. On average 1.07 ± 0.28 × 10-3 mm2 / s at 3 mm2 / s. MRI diagnosis included stages T1, T2, T3 and T4 in 57 (57.0%), 22 (22.0%), 15 (15.0%) and 6 (6.0%) patients, while the true diagnosis in histopathology was T1, T2. T3 and stage T4 in 58 (58.0%), 21 (21.0%), 15 (15.0%) and 6 (6.0%) patients. The frequency of agreement between DWI and T on MRI was 80.0%. There was a significant correlation between DWI and T staging in MR in histopathology (kappa = 0.665, p <0.001). CONCLUSION: The frequency of agreement between DWI and T MRI bladder cancer stage was 80.0%. There was a significant correlation between DWI and T staging in MR in histopathology (kappa = 0.665, p <0.001). KEYWORDS: bladder cancer, T-grade assessment, diffusion-weighted images, magnetic resonance imaging, cystoscopic biopsy, compliance.