Accuracy of contrast-enhanced ultrasound in the detection of bladder cancer

• Published in: British journal of radiology Vol. 84; no. 1008; pp. 1091 - 1099
• Main Authors: NICOLAU, C, BUNESCH, L, PERI, L, SALVADOR, R, CORRAL, J. M, MALLOFRE, C, SEBASTIA, C
• Format: Journal Article
• Language: English
• Published: London British Institute of Radiology 01-12-2011; The British Institute of Radiology
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Contrast Media; Contrast media. Radiopharmaceuticals; Cystoscopy; Female; Hematuria - diagnostic imaging; Hematuria - etiology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Pharmacology. Drug treatments; Predictive Value of Tests; Reference Standards; Retrospective Studies; Sensitivity and Specificity; Tumors of the urinary system; Ultrasonography - methods; Urinary Bladder Neoplasms - complications; Urinary Bladder Neoplasms - diagnostic imaging; Urinary Bladder Neoplasms - pathology; Urinary tract. Prostate gland; Sonography; Nuclear medicine; Urinary system disease; Echography; Radiology; Bladder disease; Urinary tract disease; Malignant tumor; Diagnosis; Bladder cancer; Contrast media; Cancer
• ISSN: 0007-1285; 1748-880X
• DOI: 10.1259/bjr/43400531

To assess the accuracy contrast-enhanced ultrasound (CEUS) in bladder cancer detection using transurethral biopsy in conventional cystoscopy as the reference standard and to determine whether CEUS improves the bladder cancer detection rate of baseline ultrasound.
43 patients with suspected bladder cancer underwent conventional cystoscopy with transurethral biopsy of the suspicious lesions. 64 bladder cancers were confirmed in 33 out of 43 patients. Baseline ultrasound and CEUS were performed the day before surgery and the accuracy of both techniques for bladder cancer detection and number of detected tumours were analysed and compared with the final diagnosis.
CEUS was significantly more accurate than ultrasound in determining presence or absence of bladder cancer: 88.37% vs 72.09%. Seven of eight uncertain baseline ultrasound results were correctly diagnosed using CEUS. CEUS sensitivity was also better than that of baseline ultrasound per number of tumours: 65.62% vs 60.93%. CEUS sensitivity for bladder cancer detection was very high for tumours larger than 5 mm (94.7%) but very low for tumours <5 mm (20%) and also had a very low negative predictive value (28.57%) in tumours <5 mm.
CEUS provided higher accuracy than baseline ultrasound for bladder cancer detection, being especially useful in non-conclusive baseline ultrasound studies.