Sarfraz Nazir MBBCh, Presenter: Nothing to Disclose

Nigel Christopher Cowan MD, Abstract Co-Author: Nothing to Disclose

Christopher G.T. Blick MD, Abstract Co-Author: Nothing to Disclose

Ben William Turney MD, Abstract Co-Author: Nothing to Disclose

Jeremy P. Crew MD, Abstract Co-Author: Nothing to Disclose

To evaluate the diagnostic accuracy of multidetector computer tomography urography (MDCTU) for diagnosing bladder cancer in patients presenting with macroscopic haematuria, over 40-years of age.

The study population consisted of 780 patients presenting with macroscopic haematuria without urinary tract infection, referred to a haematuria clinic from 01-03-2004 to 17-12-2007. Patients examined by a clinical nurse practitioner and underwent MDCTU followed by same day flexible cystoscopy. The CT examinations were read by a consultant uroradiologist and radiology resident. The flexible cystoscopies were performed by urology specialist trainees and a general practitioner with a special interest in urology. The reference standard included, flexible and rigid cystoscopy, biopsy, histopathology, clinical, imaging and histopathology follow-up. Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of MDCTU for diagnosing bladder cancer were calculated.  

The prevalence of bladder cancer was 19.2%. For MDCTU for diagnosing bladder cancer: Se = 0.85, Sp = 0.98, PPV = 0.92, and NPV = 0.96. For flexible cystoscopy with the cystoscopist having access to the MDCTU findings, Se = 0.98, Sp = 0.99, PPV = 0.95 and NPV = 0.99.  

The Se of MDCTU for diagnosing bladder cancer is not high enough for MDCTU to replace flexible cystoscopy as the primary diagnostic modality, but the high Sp of MDCTU means patients with a definite bladder cancer on MDCTU can bypass flexible cystoscopy and proceed directly to rigid cystoscopy, transurethral tumour resection and biopsy.  If this investigative route is followed, the number of flexible cystoscopies performed may be reduced and the diagnostic pathway accelerated for patients with bladder cancer.

Patients with a definite bladder cancer on MDCTU should bypass flexible cystoscopy and proceed directly to rigid cystoscopy, transurethral tumour resection and biopsy.

Nazir, S, Cowan, N, Blick, C, Turney, B, Crew, J, Evaluation of the Diagnostic Accuracy of Multidetector Computer Tomography Urography (MDCTU) for Diagnosing Bladder Cancer in Patients Presenting with Macroscopic Haematuria over 40 Years of Age.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8001252.html