Devlies Wout, de Jong Joep J, Hofmann Fabian, Bruins Harman Max, Zuiverloon Tahlita C M, Smith Emma Jane, Yuan Yuhong, van Rhijn Bas W G, Mostafid Hugh, Santesso Nancy, Violette Phil, Omar Muhammad Imran
Department of Urology, UZ Leuven, Leuven, Belgium.
Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur Urol Focus. 2024 Jan;10(1):115-122. doi: 10.1016/j.euf.2023.08.002. Epub 2023 Aug 24.
Haematuria can be macroscopic (visible haematuria [VH]) or microscopic (nonvisible haematuria [NVH]), and may be caused by a number of underlying aetiologies. Currently, in case of haematuria, cystoscopy is the standard diagnostic tool to screen the entire bladder for malignancy.
The objective of this systematic review is to determine the diagnostic test accuracy of cystoscopy (compared with other tests, eg, computed tomography, urine biomarkers, and urine cytology) for detecting bladder cancer in adults.
A systematic review of the literature was performed according to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for diagnostic test accuracy studies' checklist. The MEDLINE, Embase, Cochrane CENTRAL, and Cochrane CDSR databases (via Ovid) were searched up to July 13, 2022. The population comprises patients presenting with either VH or NVH, without previous urological cancers. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).
Overall, nine studies were included in the qualitative analysis. Seven out of nine included trials covered the use of cystoscopy in comparison with radiological imaging. Overall, sensitivity of cystoscopy ranged from 87% to 100%, specificity from 64% to 100%, positive predictive value from 79% to 98%, and negative predictive values between 98% and 100%. Two trials compared enhanced or air cystoscopy versus conventional cystoscopy. Overall sensitivity of conventional white light cystoscopy ranged from 47% to 100% and specificity from 93.4% to 100%.
The true accuracy of cystoscopy for the detection of bladder cancer within the context of haematuria has not been studied extensively, resulting in inconsistent data regarding its performance for patients with haematuria. In comparison with imaging modalities, a few trials have prospectively assessed the diagnostic performance of cystoscopy, confirming very high accuracy for cystoscopy, exceeding the diagnostic value of any other imaging test.
Evidence of tests for detecting bladder cancer in adults presenting with haematuria (blood in urine) was reviewed. The most common test used was cystoscopy, which remains the current standard for diagnosing bladder cancer.
血尿可分为肉眼血尿（可见血尿[VH]）或镜下血尿（不可见血尿[NVH]），可能由多种潜在病因引起。目前，对于血尿患者，膀胱镜检查是筛查整个膀胱是否存在恶性肿瘤的标准诊断工具。
本系统评价的目的是确定膀胱镜检查（与其他检查，如计算机断层扫描、尿液生物标志物和尿液细胞学检查相比）在检测成人膀胱癌方面的诊断试验准确性。
根据《Cochrane系统评价诊断试验准确性手册》以及《系统评价与Meta分析优先报告条目》（PRISMA）中关于诊断试验准确性研究的扩展清单，对文献进行系统评价。检索MEDLINE、Embase、Cochrane CENTRAL和Cochrane CDSR数据库（通过Ovid），检索截至2022年7月13日的文献。研究对象包括出现VH或NVH且既往无泌尿系统癌症的患者。两名研究者独立筛选所有文章，检索所获文章的参考文献列表，并进行数据提取。使用诊断准确性研究质量评估（QUADAS - 2）评估偏倚风险。
总体而言，9项研究纳入了定性分析。9项纳入试验中的7项涉及膀胱镜检查与放射影像学检查的比较。总体而言，膀胱镜检查的敏感性范围为87%至100%，特异性为64%至100%，阳性预测值为79%至98%，阴性预测值在98%至100%之间。两项试验比较了增强或空气膀胱镜检查与传统膀胱镜检查。传统白光膀胱镜检查的总体敏感性范围为47%至100%，特异性为93.4%至100%。
在血尿背景下，膀胱镜检查检测膀胱癌的真正准确性尚未得到广泛研究，导致关于其在血尿患者中的表现的数据不一致。与影像学检查相比，少数试验前瞻性评估了膀胱镜检查的诊断性能，证实膀胱镜检查具有非常高的准确性，超过任何其他影像学检查的诊断价值。
对出现血尿（尿液中带血）的成人检测膀胱癌的检查证据进行了综述。最常用的检查是膀胱镜检查，它仍然是目前诊断膀胱癌的标准。
