Abstract
To evaluate the efficacy of cystoscopy, computed tomography (CT), transcavitary ultrasound (TCUS) and cytology, separately and in combination, for the diagnosis and evaluation of superficial bladder cancer.Initial cystoscopy and wash-out cytology were performed for 1548 patients. Of these, 206 with proven bladder tumors were included in this prospective study. CT and TCUS were performed for patients with bladder tumors without knowledge of their cystoscopy results. The lesions were classified as low- (pTa) and high- (pT1) risk superficial tumors according to multiplicity and size.Patients were divided into three categories according to their cystoscopically evaluated tumor size: ≤1 cm (88 patients, 42.7%), 1–3 cm (51 patients, 24.8%) and ≥3 cm (67 patients, 32.5%). TCUS identified 46 (22.3%) high-risk patients with/without invasion and 160 (77.7%) low-risk patients with no invasion. Overall, the sensitivity, specificity, positive predictive value and negative predictive value of TCUS for tumor detection were 77.4%, 60%, 94.7% and 22.2%, respectively.Cystoscopy remains the most widely used technique for the diagnosis of bladder cancer. The combined use of CT, TCUS and cytology detected 72% of cystoscopically proven tumors. Among the three, TCUS findings exhibited the strongest correlation with cystoscopy findings.
Highlights
Initial evaluation and staging are crucial for the management of bladder cancer because the choice of curative surgical intervention or alternative therapeutic options depends on the extent of tumor invasion into the deeper layers of the bladder wall
Patients who have been down-staged may be undertreated, and those who have been up-staged may undergo unnecessary treatments, with possible resulting co-morbidities. This prospective study aimed to evaluate the efficacy of cystoscopy, computed tomography (CT), transcavitary ultrasound (TCUS) and cytology, separately and in combination, for the diagnosis and evaluation of superficial bladder cancer compared with that of pathological diagnosis
On comparison with CT, TCUS and cytology showed that CT and TCUS imaging were significantly beneficial, whereas cytology was not
Summary
Initial evaluation and staging are crucial for the management of bladder cancer because the choice of curative surgical intervention or alternative therapeutic options depends on the extent of tumor invasion into the deeper layers of the bladder wall. Pathological staging of transurethral resection (TUR) is the gold standard for this purpose. Imaging techniques such as ultrasonography, computed tomography (CT) and magnetic resonance imaging are often used to assess the clinical staging of patients. The stage determined by clinical evaluation may be incorrect compared with the pathological. This prospective study aimed to evaluate the efficacy of cystoscopy, computed tomography (CT), transcavitary ultrasound (TCUS) and cytology, separately and in combination, for the diagnosis and evaluation of superficial bladder cancer compared with that of pathological diagnosis
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