Páez Borda A, Luján Galán M, Martín Osés E, Berenguer Sánchez A
Servicio de Urología, Hospital Universitario de Getafe, Madrid, España.
Arch Esp Urol. 1997 Dec;50(10):1079-83.
Cystoscopy is the most sensitive technique for the detection of bladder tumor recurrence, but is the least accepted by the patient. In our Service, 25% of cystoscopies are poorly tolerated. Our experience with alternatives to cystoscopy is described.
Using cystoscopy as the gold standard, we analyzed the diagnostic yield of cytology, vesicorenal US and the combination of vesicorenal US and cytology. The techniques were compared for sensitivity vs 1-specificity.
The sensitivity of the alternative techniques was limited. At best it was 0.81 when US and cytology were used in combination. The specificity was low and the incidence of false negatives was 7.3%. Similarly, the diagnostic yield was better when US and cytology were used in combination (sensitivity vs 1-specificity = 0.77).
No technique, alone or in combination, can replace cystoscopy. However, alternate use of combined US and cytology with cystoscopy is efficient in the follow-up of bladder tumors and can reduce the number of cystoscopies. The delay in the diagnosis of recurrence probably has not negative negative influence on the history of the disease.
膀胱镜检查是检测膀胱肿瘤复发最敏感的技术，但却是患者最不愿接受的。在我们科室，25%的膀胱镜检查耐受性较差。本文介绍了我们在膀胱镜检查替代方法方面的经验。
以膀胱镜检查作为金标准，我们分析了细胞学检查、膀胱肾超声以及膀胱肾超声与细胞学检查联合应用的诊断效能。比较了这些技术的敏感性与1-特异性。
替代技术的敏感性有限。超声与细胞学检查联合应用时，最高敏感性为0.81。特异性较低，假阴性发生率为7.3%。同样，超声与细胞学检查联合应用时诊断效能更好（敏感性与1-特异性=0.77）。
没有任何一种技术，单独或联合应用，能够替代膀胱镜检查。然而，在膀胱肿瘤随访中，将超声与细胞学检查联合应用并交替进行膀胱镜检查是有效的，可减少膀胱镜检查次数。复发诊断的延迟可能对疾病进程没有负面影响。
