Diagnosis of bladder tumours in patients with macroscopic haematuria: A prospective comparison of split-bolus computed tomography urography, magnetic resonance urography and flexible cystoscopy

TY - JOUR

T1 - Diagnosis of bladder tumours in patients with macroscopic haematuria

T2 - A prospective comparison of split-bolus computed tomography urography, magnetic resonance urography and flexible cystoscopy

AU - Gandrup, Karen L

AU - Løgager, Vibeke B

AU - Bretlau, Thomas

AU - Nordling, Jørgen

AU - Thomsen, Henrik S

PY - 2015/6/1

Y1 - 2015/6/1

N2 - OBJECTIVE: The aim of this study was to compare split-bolus computed tomography urography (CTU), magnetic resonance urography (MRU) and flexible cystoscopy in patients with macroscopic haematuria regarding the diagnosis of bladder tumours.MATERIALS AND METHODS: In this prospective study, 150 patients underwent CTU, MRU and flexible cystoscopy. Two uroradiologists individually reviewed the images without any clinical information, using a questionnaire. Patient records and pathology reports were also reviewed.RESULTS: At flexible cystoscopy, MRU and CTU, 32, 19 and 15 bladder lesions were identified, respectively. Histopathology showed that 13 of the 29 biopsied lesions were transitional cell carcinomas. Compared with the histopathology, the sensitivity and specificity for detection of tumours by CTU and MRU were 61.5% and 94.9%, and 79.9% and 93.4%, respectively. False-positive detection of bladder tumours, compared with histopathology, was reported in seven CTUs and nine MRUs, whereas the number of false-negative findings was five for CTUs and three for MRUs.CONCLUSIONS: Split-bolus CTU or MRU cannot replace cystoscopy in cases of macroscopic haematuria. MRU has a higher sensitivity than split-bolus CTU, and is a potential alternative to flexible cystoscopy. Patients with a low risk of bladder cancer may forgo flexible cystoscopy if a bladder tumour is identified by either CTU or MRU, and proceed straight to transuretheral resection of the bladder.

AB - OBJECTIVE: The aim of this study was to compare split-bolus computed tomography urography (CTU), magnetic resonance urography (MRU) and flexible cystoscopy in patients with macroscopic haematuria regarding the diagnosis of bladder tumours.MATERIALS AND METHODS: In this prospective study, 150 patients underwent CTU, MRU and flexible cystoscopy. Two uroradiologists individually reviewed the images without any clinical information, using a questionnaire. Patient records and pathology reports were also reviewed.RESULTS: At flexible cystoscopy, MRU and CTU, 32, 19 and 15 bladder lesions were identified, respectively. Histopathology showed that 13 of the 29 biopsied lesions were transitional cell carcinomas. Compared with the histopathology, the sensitivity and specificity for detection of tumours by CTU and MRU were 61.5% and 94.9%, and 79.9% and 93.4%, respectively. False-positive detection of bladder tumours, compared with histopathology, was reported in seven CTUs and nine MRUs, whereas the number of false-negative findings was five for CTUs and three for MRUs.CONCLUSIONS: Split-bolus CTU or MRU cannot replace cystoscopy in cases of macroscopic haematuria. MRU has a higher sensitivity than split-bolus CTU, and is a potential alternative to flexible cystoscopy. Patients with a low risk of bladder cancer may forgo flexible cystoscopy if a bladder tumour is identified by either CTU or MRU, and proceed straight to transuretheral resection of the bladder.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Biopsy

KW - Carcinoma, Transitional Cell

KW - Cystoscopy

KW - Diagnostic Errors

KW - Female

KW - Hematuria

KW - Humans

KW - Incidence

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Sensitivity and Specificity

KW - Tomography, X-Ray Computed

KW - Urinary Bladder

KW - Urinary Bladder Neoplasms

KW - Urography

U2 - 10.3109/21681805.2014.981203

DO - 10.3109/21681805.2014.981203

M3 - Journal article

C2 - 25438986

SN - 2168-1805

VL - 49

SP - 224

EP - 229

JO - Scandinavian Journal of Urology and Nephrology

JF - Scandinavian Journal of Urology and Nephrology

IS - 3

ER -