背景:血尿可以是宏观的(可见血尿[VH])或微观的(非可见血尿[NVH]),可能是由许多潜在的病因引起的。目前,在血尿的情况下,膀胱镜检查是筛查整个膀胱恶性肿瘤的标准诊断工具.
目的:本系统评价的目的是确定膀胱镜检查的诊断测试准确性(与其他测试相比,例如,计算机断层扫描,尿液生物标志物,和尿细胞学)用于检测成人膀胱癌。
方法:根据《Cochrane诊断测试准确性系统评价手册》和用于诊断测试准确性研究的系统评价和荟萃分析(PRISMA)扩展的首选报告项目》对文献进行系统评价。MEDLINE,Embase,科克伦中部,和CochraneCDSR数据库(通过Ovid)在2022年7月13日之前进行了搜索。人群包括患有VH或NVH的患者,没有以前的泌尿系癌症。两名审稿人独立筛选所有文章,搜索检索到的文章的参考列表,并进行数据提取。使用诊断准确性研究质量评估(QUADAS-2)评估偏倚风险。
结果:总体而言,9项研究纳入了定性分析.与放射学成像相比,9项纳入的试验中有7项涵盖了膀胱镜检查的使用。总的来说,膀胱镜检查的敏感度从87%到100%,特异性从64%到100%,阳性预测值从79%到98%,阴性预测值在98%至100%之间。两项试验比较了增强膀胱镜检查或空气膀胱镜检查与常规膀胱镜检查。常规白光膀胱镜检查的总体敏感性为47%至100%,特异性为93.4%至100%。
结论:膀胱镜检查在血尿背景下检测膀胱癌的真正准确性尚未得到广泛研究,导致血尿患者的表现数据不一致。与成像模式相比,一些试验前瞻性地评估了膀胱镜检查的诊断性能,确认膀胱镜检查的准确性非常高,超过任何其他影像学检查的诊断价值。
结果:回顾了在出现血尿(尿中有血)的成人中检测膀胱癌的试验证据。最常用的检查是膀胱镜检查,这仍然是目前诊断膀胱癌的标准。
BACKGROUND: Haematuria can be macroscopic (visible haematuria [VH]) or microscopic (nonvisible haematuria [NVH]), and may be caused by a number of underlying aetiologies. Currently, in case of haematuria,
cystoscopy is the standard diagnostic tool to screen the entire bladder for malignancy.
OBJECTIVE: The objective of this systematic review is to determine the diagnostic test accuracy of cystoscopy (compared with other tests, eg, computed tomography, urine biomarkers, and urine cytology) for detecting bladder cancer in adults.
METHODS: A systematic review of the literature was performed according to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for diagnostic test accuracy studies\' checklist. The MEDLINE, Embase, Cochrane CENTRAL, and Cochrane CDSR databases (via Ovid) were searched up to July 13, 2022. The population comprises patients presenting with either VH or NVH, without previous urological cancers. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).
RESULTS: Overall, nine studies were included in the qualitative analysis. Seven out of nine included trials covered the use of
cystoscopy in comparison with radiological imaging. Overall, sensitivity of cystoscopy ranged from 87% to 100%, specificity from 64% to 100%, positive predictive value from 79% to 98%, and negative predictive values between 98% and 100%. Two trials compared enhanced or air
cystoscopy versus conventional
cystoscopy. Overall sensitivity of conventional white light
cystoscopy ranged from 47% to 100% and specificity from 93.4% to 100%.
CONCLUSIONS: The true accuracy of
cystoscopy for the detection of bladder cancer within the context of haematuria has not been studied extensively, resulting in inconsistent data regarding its performance for patients with haematuria. In comparison with imaging modalities, a few trials have prospectively assessed the diagnostic performance of cystoscopy, confirming very high accuracy for cystoscopy, exceeding the diagnostic value of any other imaging test.
RESULTS: Evidence of tests for detecting bladder cancer in adults presenting with haematuria (blood in urine) was reviewed. The most common test used was cystoscopy, which remains the current standard for diagnosing bladder cancer.