The usefulness of cystoscopy in the staging of cervical cancer

Objective. The aim of this study was to clarify the usefulness of cystoscop y in the staging of cervical cancer and to evaluate the clinical indication s for performing ureteric catheterization to rule out ureteral obstruction in cervical cancer. Methods. Both rigid cystoscopy and CT were performed before treatment in pa tients with cervical cancer of FIGO stage IB or greater. Cystoscopically di rected biopsy specimens were taken from all areas in the bladder which were suspected of cancerous development. If a jet of urine spurting from each u reteral orifice was not found, a ureteric catheter was inserted into the or ifice to rule out ureteral obstruction. The cystoscopic findings were compa red with a CT examination. Results. A total of 100 patients were included in the study (mean age 59 ye ars). There were 30 stage IB cancers, 20 stage IIA, 17 stage IIB, 5 stage I IIA, 18 stage IIIB, and 10 stage IV. A total of 90 patients had squamous ce ll carcinomas and 10 had adenocarcinomas. Cystoscopy identified 8 patients with bladder invasion including 1 stage IIIA, 2 stage IIIB, and 5 stage IV. All of these patients had CT indication of possible invasion. CT indicatio n of possible invasion was proved to be false by cystoscopy in 2 patients. Both the sensitivity and the negative predictive value of CT for bladder in vasion were 100%. Of the 14 patients in whom ureteral obstruction was diagn osed by ureteric catheterization, 11 cases were indicated by CT scan, but f or the other 3 patients CT found no significant ureteral obstruction. Conclusions. The results of this study suggest that cystoscopy is indicated only in cervical cancer patients for whom CT examination indicates possibl e bladder invasion. In addition, the results suggest that placement of uret eric catheterization using cystoscopy to rule out ureteral obstruction is n ot indicated in the staging of cervical cancer. a 2000 Academic Press.