Application Value Of Contrast-enhanced Ultrasound In Bladder Cancer Staging And Grading

Subject:1. To evaluate diagnostic value of contrast-enhanced ultrasound(CEUS) for detecting invasive and noninvasive bladder cancer with Meta analysis.2. To evaluate clinical application value of contrast-enhanced ultrasound(CEUS)in identifying invasive and non-invasive bladder cance.3. To explore the application value of contrast-enhanced ultrasound combined with time-intensity curve(TIC) on identify high and low grade bladder urothelial carcinoma.Methods:1. We retrieved relevant literatures, including Pubmed,EMBASE,Cochrane Library,CBM,WANFANG DATA. Meta –analysis were used to pooled data, draw summary receiver operating characteristic(SROC) curves,calculated area under the curve(AUC).2. Collect pathologically confirmed 85 cases of bladder cancer patients,two investigators analysis the images of contrast-enhanced ultrasound, to determine whether the tumor infiltrating muscular layer and calculate diagnostic accuracy index respectively.3. We retrospectively analyzed 62 patients with bladder urothelial carcinoma(low grade group were 40 and high grade were 22) according to pathologic examination. TIC parameters included rise time(RT), peak intensiy(PI), mean transit time(MTT), time from peak to one half(TPH), time to peak(TP),wash in slope(WIS), semi-descending slope(DS) were acquired and CEUS characteristics were analyzed by QLab software.Results:1. The pooled SEN,SPE,PLR,NLR,DOR and 95%CI were 0.95(0.87~0.99)、0.93(0.86~0.97)、13.08(6.25~27.34)、0.06(0.03~0.16)、226.75(57.31~897.10). The AUC of SROC was 0.98.2. Pathologically confirmed 85 cases of 33 patients with invasive bladder cancer cases and 52 non-infiltrative. Researchers 1 diagnosed 37 cases as infiltrating, 48 cases of non invasive. Researchers 1diagnosis the sensitivity, specificity and accuracy of the invasive type of bladder cancer were 93.94%, 88.46% and 90.59% respectively.Researchers 2 diagnosed 36 cases as infiltrating, 49 cases of non invasive.Researchers 2 diagnosis the sensitivity, specificity and accuracy of the invasive type of bladder cancer were 93.94% 、 90.38% and 91.76% respectively. According to consistency test, between the two researchers, between researchers and pathologic examination have good consistency( the Kappa value were 0.86, 0.83, 0.85 respectively,all P <0.01).3. There were no statistically significantly differences in morphology, number,internal echo, basilar part and color flow of the tumors between high and low grade groups; the TPH was higher and DS was lower in high grade group than in low grade group(TPH: t=-4.17, P<0.01; DS: t=-2.77, P=0.01), but RT, PI, MTT, TP, WIS were no statistically significant between two groups(all P>0.05). The best cut-off point as identify high and low grade bladder urothelial carcinoma of TPH and DS were 58.06 s and 0.02 d B/s, and the area under the curve were 0.79.Conclusion:1. Contrast-enhanced ultrasound has a high diagnostic accuracy for detection invasive and noninvasive bladder cancer, but still need more diagnostic tests in order to provide more adequate evidence-based evidence.2. Contrast-enhanced ultrasound have high diagnostic efficiency for identify invasive and non-invasive bladder cancer. The results were stable,consistency was good.3. There is certain differential diagnosis value of contrast-enhanced ultrasound time-intensity curve quantization parameters in the high and low grade bladder urothelial carcinoma.