J Korean Soc Radiol.  2018 Jul;79(1):33-39. 10.3348/jksr.2018.79.1.33.

Diagnostic Strategy of CT Urography as a Prior Examination in the Detection of Bladder Cancer

• Nam YK
• Kim SH
• Kim MJ
• Lee HJ
• Cho SH

• KMID: 2416403
• DOI: http://doi.org/10.3348/jksr.2018.79.1.33

Abstract

PURPOSE
To prospectively assess the diagnostic potential of computed tomography urography (CTU) as a prior examination in the detection of bladder cancer.
MATERIALS AND METHODS
A total of 3280 CTU examinations were assessed in 3050 consecutive patients. Patients who were over 35 years of age, with gross hematuria, persistent microhematuria, or a history of urothelial tumor, were included in our study. Our study investigated the diagnostic capability of CTU over the course of two prior examinations. After the first examination, patients with a definite lesion observed by CTU were referred directly for rigid cystoscopy (RC) and patients with negative or probable lesion were referred for flexible cystoscopy (FC). After the second examination, patients with a definite lesion observed by CTU were referred directly for RC, patients with probable lesion were referred for FC, and patients with negative lesion were referred for clinical follow-up. Performance characteristics for the two prior examinations were determined by using pathologic findings or clinical follow-up as the reference standard.
RESULTS
The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting bladder cancer were 95.2%, 95.4%, 95.4%, 69.1%, and 99.2%, respectively, for the first prior examination, and 93.4%, 93.3%, 93.3%, 61.1%, and 98.4%, respectively, for the second prior examination.
CONCLUSION
CTU as a prior examination is accurate for the early detection of bladder cancer. Notably, when used as a second prior examination, CTU could help to avoid the unnecessary use of FC in patients with negative lesions.

MeSH Terms

Cystoscopy
Follow-Up Studies
Hematuria
Humans
Prospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed
Urinary Bladder Neoplasms*
Urinary Bladder*
Urography*

Figure

• 

  ABCFig. 1 A 51-year-old woman who had adherent clot in the bladder wall. A, B. A contrast enhanced CT urography on nephrography (A) and pyelography (B) phases show a 20 mm sized probable lesion (arrows) along the anterior wall. C. Corresponding flexible cystoscopy reveals adherent blood clot.

• 

  ABCFig. 2 A 75-year-old man who had bladder cancer (Grade 1 and stage T2a). A, B. A contrast enhanced CT urography on nephrography (A) and pyelography (B) phases show a 10 mm sized definite lesion (arrows) near the left basal wall. C. Corresponding rigid cystoscopy and biopsy reveals bladder cancer.

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