Comparison of CT Scan and Cystoscopy findings of Bladder Involvement in Patients of Carcinoma Cervix in View of Revised FIGO Staging: A Cross-sectional Study

Introduction: Cervical cancer is the 5th most common cancer in humans and the second most common cancer in women worldwide. Bladder invasion is an important prognostic factor and adversely affects the clinical outcome and detecting true bladder invasion is extremely important for prognostication and treatment in patients of cervical cancer. Cystoscopy was the approved method for assessing involvement of the bladder according to International Federation of Gynecology and Obstetrics (FIGO) staging until the revised FIGO staging 2009 which encourages the use of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scan and does not recommend cystoscopy as mandatory investigation. Aim: To compare the role of CT scan of pelvis and cystoscopy for bladder involvement in carcinoma cervix. Materials and Methods: This cross-sectional study was conducted on 100 patients of carcinoma cervix admitted in the Gynaecology wards of Government Medical College, Patiala, Punjab, India, from January 2015 to December 2015. The study involved cystoscopy and CT scan pelvis which were done for pretreatment assessment of all patients who were histopathologically proven to be carcinoma cervix. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of CT scan were calculated. Results: The majority (33%) of patients belonged to 51-60 years age group with mean age of 50.86 +/- 10.75 years. True positives were six cases, where bladder involvement on cystoscopy was histopathologically proven. True negatives were 72 cases where bladder was not involved on CT and cystoscopy. False positive were cases which were involved on CT scan but negative on cystoscopy for bladder involvement which came out to be 22. No false negatives were observed in which bladder was not involved on CT scan but showed involvement on cystoscopy in the present study. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT scan came out to be 100%, 76.60%, 21.43%, 100% and 78%, respectively. Conclusion: The positive findings of CT scan for bladder involvement can be used to select patients who need to undergo cystoscopy as CT scan is a moderately accurate modality for assessing bladder involvement in patients of carcinoma cervix. The 100% NPV observed in our study is encouraging to suggest that it can be used as primary modality to avoid invasive procedure like cystoscopy in women with carcinoma cervix specially with CT negative findings for bladder involvement.