Diagnostic Accuracy of Transitional Cell Carcinoma on Multidetector Computerized Tomography Urography in Patients With Gross Hematuria

Purpose: We analyzed the diagnostic value of multidetector computerized tomography urography for transitional Cell carcinoma in patients with gross hematuria. Materials and Methods: All consecutive adult patients with gross hematuria who underwent multidetector computerized tomography urography in a 23 month period were prospectively enrolled. Transitional cell carcinoma an its location on multidetector computerized tomography urography were recorded at a prospective reading with knowledge of the pertinent history and at a retrospective reading while blinded to all information. Histological evidence of transitional cell carcinoma served as the gold standard for final diagnosis. Patients who were lost to followup, refused biopsy/surgery for clinically suspicious neoplasms or had negative diagnostic evaluation but a followup of less than I year were excluded from study. We analyzed the diagnostic value of multidetector computerized tomography urography for transitional cell carcinoma by location with reference to final diagnosis. Results: A total of 139 patients were eligible for study, of whom 24 were excluded from analysis. There was no difference in demographic features between included and excluded patients. Of the 115 included patients 60 had a final diagnosis of a total of 77 transitional cell carcinomas in the renal pelvis, ureter or bladder. Overall sensitivity, specificity and accuracy of multidetector computerized tomography urography for diagnosing transitional cell carcinoma were 0.857, 0.980 and 0.963 at the retrospective reading, and 0.961, 0.988 and 0.984 at the prospective reading, respectively. Multidetector computerized tomography urography had the highest accuracy for diagnosing renal transitional cell carcinoma and the lowest sensitivity for detecting ureteral transitional cell carcinoma. Conclusions: Multidetector computerized tomography urography is an accurate, noninvasive imaging modality for diagnosing transitional cell carcinoma in patients with gross hematuria. However, careful assessment of the ureter for multidetector computerized tomography urography is required for detecting ureteral transitional cell carcinoma.