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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.
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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.
Table 1.
Patients Characteristics
Table 2.
Prevalence of Bladder Cancer and CT Urography Use Categorized by Examination Indication
Table 3.
Prevalence of Bladder Cancer and CT Urography Use Categorized by Patients’ Age
Table 4.
Performance Characteristics of CT Urography as a First Prior Examination and a Second Prior Examination for Detecting Bladder Cancer Categorized by Examination Indication
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