CT urography useful in diagnosing bladder cancer

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NEW YORK (Reuters Health), Aug 22 - Use of CT urography to evaluate macroscopic hematuria possibly due to bladder cancer obviates the need for intravenous urogram and ultrasound and can help determine whether cystoscopy is warranted, new research suggests.

CT urography is the current "gold standard" for evaluating the upper urinary tract. However, no consensus has been reached regarding its role in investigating hematuria.

As reported in the August issue of BJU International, Dr. Nigel C. Cowan and colleagues, from the Churchill Hospital in Oxford, U.K., compared CT urography and cystoscopy results in 200 consecutive patients, over 40 years of age, who presented with macroscopic hematuria and had no urinary tract infection.

Twenty-four percent of patients had bladder cancer, the report indicates.

Compared with the histopathological findings obtained with cystoscopy, CT urography yielded one false-positive and three false-negative findings, resulting in a sensitivity of 93%, a specificity of 99% for bladder cancer diagnosis.

Further analysis of the false-negative cases showed that one was missed on the initial CT urography reporting, one resembled prostate cancer on CT urography and the third was squamous metaplasia.

"Our results support the use of CT urography as a first-line screening tool for this high-risk group, the use of which will obviate the need for flexible cystoscopy in patients with a negative CT urography and allow those with an obvious tumor to be referred directly for rigid cystoscopy and resection," the authors conclude. "The remaining patients should be referred for flexible cystoscopy."

Last Updated: 2006-08-21 16:26:58 -0400 (Reuters Health)

BJU Int 2006;98:345-348.

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