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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:887-894 • 0278-4297

Correlation of Transabdominal Sonographic and Cystoscopic Findings in the Diagnosis of Focal Abnormalities of the Urinary Bladder Wall

A Prospective Study

Giampiero Francica, MD, Sergio Adamo Bellini, MD, Ferdinando Scarano, MD, Antonio Miragliuolo, MD, Fedele Antonio De Marino, MD and Mauro Maniscalco, MD

Diagnostic and Interventional Ultrasound Service (G.F., F.S., F.A.D.M.), Urologic Surgery Unit (S.A.B., A.M.), and Department of Medicine (M.M.), Presidio Ospedaliero Camilliani Santa Maria Della Pietà, Casoria, Italy.

Address correspondence to Giampiero Francica, MD, Servizio di Ecografia Diagnostica ed Interventistica, Presidio Ospedaliero Camilliani Santa Maria Della Pietà, Via San Rocco 9, 80026 Casoria (NA), Italy. E-mail: giampierofrancica{at}tin.it

Objective. The aim of this study was to prospectively assess the diagnostic capabilities of transabdominal sonography performed with newer sonography machines for showing focal bladder wall abnormalities (FBWAs) detected on cystoscopy. Methods. One hundred twelve consecutive patients (97 male and 15 female; mean age, 68 years) underwent cystoscopy. Reasons for referral were macroscopic hematuria (44 cases [39%]), surveillance after transurethral resection (56 cases [49.5%]), and incidental sonographic findings (12 cases [11.5%]). One to 2 days before cystoscopy, sonography was carried out by a single operator who was blinded to clinical and recent sonographic findings. The presence, size, number, and location of FBWAs (eg, polypoid vegetations and asymmetric bladder wall thickening) were recorded and compared with cystoscopic and histologic findings. Results. One hundred ten patients with a histologic diagnosis were available for the study. Benign conditions, nontransitional tumors, and transitional tumors were found in 26.3%, 3.7% and 70% of the patients, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of sonography of cystoscopic lesions were 91.4%, 79.3%, 91.4%, 79.3%, and 88.2%. Cancers of 15 mm or smaller and flat tumors were often missed by sonography, whereas chronic cystitis accounted for most of the false-positive sonographic findings; however, sonography had poor capability of characterizing FBWAs, with specificity of 62%. In this respect, color Doppler findings proved of little aid as well. Conclusions. In patients selected for cystoscopy, transabdominal sonography with newer sonography machines showed good diagnostic accuracy for focal alterations of the bladder wall found on cystoscopy.

Key Words: bladder • cystoscopy • sonography • urothelial cancer

Abbreviations: FBWA, focal bladder wall abnormality • SCI, spatial compound imaging • THI, tissue harmonic imaging • TUR, transurethral resection

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.