Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Diagnostic Strategy of CT Urography as a Prior Examination in the Detection of Bladder Cancer

방광암의 선별검사로서 컴퓨터단층촬영 요로 조영술의 진단 전략

  • Nam, Yeo Kyoung (Department of Radiology, Keimyung University, Dongsan Hospital) ;
  • Kim, See Hyung (Department of Radiology, Keimyung University, Dongsan Hospital) ;
  • Kim, Mi Jeong (Department of Radiology, Keimyung University, Dongsan Hospital) ;
  • Lee, Hee Jung (Department of Radiology, Keimyung University, Dongsan Hospital) ;
  • Cho, Seung Hyun (Department of Radiology, Kyungbook National University Hospital)
  • 남여경 (계명대학교 동산의료원 영상의학과) ;
  • 김시형 (계명대학교 동산의료원 영상의학과) ;
  • 김미정 (계명대학교 동산의료원 영상의학과) ;
  • 이희정 (계명대학교 동산의료원 영상의학과) ;
  • 조승현 (경북대학교병원 영상의학과)
  • Received : 2017.12.08
  • Accepted : 2018.04.21
  • Published : 2018.07.01
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Abstract

Purpose: To prospectively assess the diagnostic potential of computed tomography urography (CTU) as a prior examination in the detection of bladder cancer. Materials and Methods: A total of 3280 CTU examinations were assessed in 3050 consecutive patients. Patients who were over 35 years of age, with gross hematuria, persistent microhematuria, or a history of urothelial tumor, were included in our study. Our study investigated the diagnostic capability of CTU over the course of two prior examinations. After the first examination, patients with a definite lesion observed by CTU were referred directly for rigid cystoscopy (RC) and patients with negative or probable lesion were referred for flexible cystoscopy (FC). After the second examination, patients with a definite lesion observed by CTU were referred directly for RC, patients with probable lesion were referred for FC, and patients with negative lesion were referred for clinical follow-up. Performance characteristics for the two prior examinations were determined by using pathologic findings or clinical follow-up as the reference standard. Results: The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting bladder cancer were 95.2%, 95.4%, 95.4%, 69.1%, and 99.2%, respectively, for the first prior examination, and 93.4%, 93.3%, 93.3%, 61.1%, and 98.4%, respectively, for the second prior examination. Conclusion: CTU as a prior examination is accurate for the early detection of bladder cancer. Notably, when used as a second prior examination, CTU could help to avoid the unnecessary use of FC in patients with negative lesions.

목적: 방광암의 선별검사로서 컴퓨터단층촬영 요로 조영술(computed tomography urography; 이하 CTU)의 진단 전략에 대해 전향적으로 평가하였다. 대상과 방법: 35세 이상의 육안적 혈뇨, 지속적 현미경적 혈뇨, 또는 요로 상피종양 병력이 있는 3050명 환자의 3280개 CTU를 대상으로 하였다. 이 연구는 두 가지 방법으로 사전 검사로써의 CTU를 평가하였다. 첫 번째, CTU에서 명확한 병변이 있는 환자는 경성 방광경(rigid cystoscopy; 이하 RC)을, 음성 또는 가능성 있는 병변을 가진 환자는 굴곡성 방광경(flexible cystoscopy; 이하 FC)을 시행하였다. 두 번째, CTU에서 명확한 병변이 있는 환자는 RC, 가능성 있는 병변을 가진 환자는 FC, 음성은 임상적 추적 관찰을 시행하였다. 병리 소견 또는 임상적 추적 관찰을 두 가지 사전 검사의 진단 유용성(performance characteristics)의 표준 지표(reference standard)로 사용하였다. 결과: 방광암의 발견에 대한 민감도, 특이도, 정확도, 양성 예측도, 음성 예측도는 첫 번째 방법에서는 95.2%, 95.4%, 95.4%, 69.1%, 99.2%, 두 번째 방법에서는 93.4%, 93.3%, 93.3%, 61.1%, 98.4%로 나타났다. 결론: 방광암 진단에 있어 사전 검사로써의 CTU는 정확하며, 특히 두 번째 검사 전략으로써의 CTU는 음성 병변이 있는 환자에서 FC의 추가 사용을 감소시킬 수 있다.

Keywords

References

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