Sadow Cheryl A, Silverman Stuart G, O'Leary Michael P, Signorovitch James E
Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
Radiology. 2008 Oct;249(1):195-202. doi: 10.1148/radiol.2491071860.
To evaluate the performance characteristics of computed tomographic (CT) urography for the detection of bladder cancer in patients at risk for the disease.
Institutional review board approval was obtained for this retrospective HIPAA-compliant review of medical records of 2600 consecutive patients undergoing CT urography. Of these, 838 CT urograms in 779 patients (449 men, mean age of 62 years, range of 27-92 years; 330 women, mean age of 56 years, range of 18-86 years) evaluated for hematuria or a history of urothelial cancer, who had undergone cystoscopy within 6 months of the CT urogram, were included in the study. Clinical reports of CT urograms containing a bladder lesion interpreted as suspicious for malignancy were classified as positive. All others were classified as negative. Cystoscopy reports were classified as positive if a lesion underwent biopsy or was resected or negative if no lesion was detected. Performance characteristics for both CT urography and cystoscopy were determined by using pathologic findings or clinical follow-up as the reference standard. Ninety-five percent confidence intervals were estimated for each test characteristic.
The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) for bladder cancer detection were 79% (117 of 149), 94% (649 of 689), 91% (766 of 838), 75% (117 of 157), and 95% (649 of 681) for CT urography and 95% (142 of 149), 92% (634 of 689), 93% (776 of 838), 72% (142 of 197), and 99% (634 of 641) for cystoscopy. The NPV of CT urography was higher in patients evaluated for hematuria alone (98%, 589 of 603). However, the accuracy of CT urography was considerably lower in patients with a prior urothelial malignancy (78%, 123 of 158).
CT urography is an accurate noninvasive test for detecting bladder cancer in patients at risk for the disease. The high NPV of CT urography in patients with hematuria may obviate cystoscopy in selected patients.
评估计算机断层扫描（CT）尿路造影对膀胱癌高危患者膀胱癌的检测性能特征。
本研究经机构审查委员会批准，对2600例连续接受CT尿路造影的患者的病历进行了符合《健康保险流通与责任法案》（HIPAA）的回顾性研究。其中，对779例患者（449例男性，平均年龄62岁，范围27 - 92岁；330例女性，平均年龄56岁，范围18 - 86岁）进行血尿或尿路上皮癌病史评估，并在CT尿路造影后6个月内接受膀胱镜检查，共838例CT尿路造影纳入研究。CT尿路造影临床报告中包含被解释为可疑恶性的膀胱病变被分类为阳性。所有其他报告分类为阴性。膀胱镜检查报告中，病变进行活检或切除则分类为阳性，未检测到病变则分类为阴性。以病理结果或临床随访作为参考标准，确定CT尿路造影和膀胱镜检查的性能特征。对每个检测特征估计95%置信区间。
CT尿路造影检测膀胱癌的总体敏感性、特异性、准确性、阳性预测值和阴性预测值分别为79%（149例中的117例）、94%（689例中的649例）、91%（838例中的766例）、75%（157例中的117例）和95%（681例中的649例）；膀胱镜检查的相应结果分别为95%（149例中的142例）、92%（689例中的634例）、93%（838例中的776例）、72%（197例中的142例）和99%（641例中的634例）。仅评估血尿的患者中，CT尿路造影的阴性预测值更高（98%，603例中的589例）。然而，既往有尿路上皮恶性肿瘤的患者中，CT尿路造影的准确性显著较低（78%，158例中的123例）。
CT尿路造影是检测膀胱癌高危患者膀胱癌的一种准确的非侵入性检查。CT尿路造影在血尿患者中的高阴性预测值可能使部分患者无需进行膀胱镜检查。
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