Sadow CA et al. (2008) Bladder cancer detection with CT urography in an Academic Medical Center. Radiology 249: 195–202

Cystoscopy is the reference standard for bladder cancer detection, and is also used to monitor patients with a history of the disease. The procedure is, however, invasive, and some patients find the experience uncomfortable. In search of a noninvasive, image-based alternative, Sadow et al. investigated whether CT urography can accurately detect bladder cancer in patients at risk for the disease.

A total of 838 CT urograms from 779 patients (449 men, mean age 62 years; 330 women, mean age 56 years) under evaluation for hematuria (a common symptom of bladder cancer) or with a history of urothelial cancer were retrospectively analyzed. All patients underwent cystoscopy within 6 months of the CT assessment. Overall, 149 bladder cancers were detected on CT urograms (displaying bladder lesions considered as suspicious for malignancy) in 133 patients. Of the 838 CT urograms examined, 766 (91.4%) were interpreted accurately; cystoscopy was 92.6% accurate (determined using clinical follow-up or pathologic findings). CT urography was found to be as accurate as cystoscopy for patients with hematuria, (94.6% and 94.4% accurate, respectively). Both tests showed lower accuracy in the evaluation of patients with a history of urothelial cancer than in patients with hematuria, CT urography more so than cystoscopy (77.8% vs 84.8%).

Sadow et al. conclude that CT urography is an accurate, noninvasive technique for detecting bladder cancer, and could be particularly useful in identifying patients with hematuria who may not need further investigation with cystoscopy. Cystoscopy should still, however, be favored for patients with a history of urothelial cancer.