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Bladder Cancer Diagnosis with CT Urography: Test Characteristics and Reasons for False-positive and False-negative Results

Institution:
Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA. twtrinh@bwh.harvard.edu.
Publisher:
Springer
Publication Date:
Mar-2018
Journal:
Abdom Radiol (NY)
Volume Number:
43
Issue Number:
3
Pages:
663-71
Citation:
Abdom Radiol (NY). 2018 Mar;43(3):663-71.
PubMed ID:
28677000
Keywords:
Bladder cancer, CT urography, False positive, False negative, Performance characteristics
Appears in Collections:
NCIGT, SPL
Sponsors:
P41 EB015898/EB/NIBIB NIH HHS/United States
Generated Citation:
Trinh T.W., Glazer D.I., Sadow C.A., Sahni V.A., Geller N.L., Silverman S.G. Bladder Cancer Diagnosis with CT Urography: Test Characteristics and Reasons for False-positive and False-negative Results. Abdom Radiol (NY). 2018 Mar;43(3):663-71. PMID: 28677000.
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PURPOSE: To determine test characteristics of CT urography for detecting bladder cancer in patients with hematuria and those undergoing surveillance, and to analyze reasons for false-positive and false-negative results. METHODS: A HIPAA-compliant, IRB-approved retrospective review of reports from 1623 CT urograms between 10/2010 and 12/31/2013 was performed. 710 examinations for hematuria or bladder cancer history were compared to cystoscopy performed within 6 months. Reference standard was surgical pathology or 1-year minimum clinical follow-up. False-positive and false-negative examinations were reviewed to determine reasons for errors. RESULTS: Ninety-five bladder cancers were detected. CT urography accuracy: was 91.5% (650/710), sensitivity 86.3% (82/95), specificity 92.4% (568/615), positive predictive value 63.6% (82/129), and negative predictive value was 97.8% (568/581). Of 43 false positives, the majority of interpretation errors were due to benign prostatic hyperplasia (n = 12), trabeculated bladder (n = 9), and treatment changes (n = 8). Other causes include blood clots, mistaken normal anatomy, infectious/inflammatory changes, or had no cystoscopic correlate. Of 13 false negatives, 11 were due to technique, one to a large urinary residual, one to artifact. There were no errors in perception. CONCLUSION: CT urography is an accurate test for diagnosing bladder cancer; however, in protocols relying predominantly on excretory phase images, overall sensitivity remains insufficient to obviate cystoscopy. Awareness of bladder cancer mimics may reduce false-positive results. Improvements in CTU technique may reduce false-negative results.