Prediction of Grade of Urothelial Carcinoma of Urinary Bladder from the Size and Number of Tumors at First Presentation

Background: Early diagnosis and prompt treatment can save lives of the patients with bladder cancer. The confirmatory test for grade of the disease is histopathological examination after transurethral resection. But if the grade of the tumor can be predicted at the time of presentation from size and number of tumors seen by ultrasonographic imaging, clinician can counsel the patient beforehand and also arrange rapid treatment to save life. Objective: To assess the size and number of tumors as clinical predictors of histological grade of urothelial carcinoma of urinary bladder before first-time transurethral resection of the bladder tumor (TURBT). Methods: This cross-sectional study was conducted in the Department of Urology, BSMMU and RGRH from January 2020 to April 2020. Fifty patients were enrolled in this study. Size and number of the tumor was determined by preoperative ultrasonography of urinary bladder. Histopathological examination was used to determine the grade of the tumor after TURBT. Statistical analysis was performed using SPSS version 22.0. Results: Mean age of the study subjects was 52.04 ± 18.37 years within the range of 22–95 years. Males (56.0%) were predominant than females (44.0%). Male to female ratio was 1.27:1. Mean number of tumor was 1.28 ± 0.64 (1-3) and mean tumor size was 3.54 ± 1.47 cm (1-7). High grade tumor was 26 (52.0%) and low grade tumor was 24 (48.0%). There was no significant association of tumor grading with number of tumor in this study. High grade tumor was significantly higher among the study subjects with tumor size >3.5 cm. Area under curve (AUC) of tumor number and tumor size was 0.558 and 0.827 respectively in prediction of tumor grading. Sensitivity, specificity, PPV, NPV and accuracy of tumor number (at cut of value 3) was 15.4%, 95.8%, 80.0%, 51.1% and 54.0% respectively. Sensitivity, specificity, PPV, NPV and accuracy of tumor size (at cut of value 3.5 cm) was 90.5%, 76.3%, 80.9%, 87.9% and 83.7% respectively. Overall Sensitivity, specificity, PPV, NPV and accuracy of tumor size was better than tumor number in prediction of tumor grading. Conclusion: According to this study finding, it can be concluded that the grade of newly diagnosed bladder tumors can be predicted with high accuracy using tumor size.