| Background and Objective: Bladder tumor is one of the most common urological tumors with morbidity and mortality in our country.Its incidence is increasing year by year,accounting for 3.2% of all malignant tumors.Urothelial tumors account for more than 95% of all bladder tumors.There is a gender difference in the incidence of bladder cancer.In general statistics,the incidence of men is three times that of women.Intermittent whole course painless hematuria is the most common clinical symptom of bladder cancer,and the initial symptoms of some patients can be manifested as bladder irritation.Some of the newly diagnosed cases of bladder cancer are characterized by superficial tumors often presenting as Ta-T1 stage.Such superficial tumors have less distant metastasis but high recurrence.The early detection and diagnosis of the bladder tumor are particularly important because the disease is easy to relapse,and the malignancy of some patients with recurrence is increased,even infiltration and metastasis.For patients with stage Ta-T1 bladder cancer,the main treatment is transurethral resection of bladder tumor(TURBT),and postoperative bladder perfusion usually is local chemotherapy.Cystoscopy is an an indispensable examination method for early diagnosis of bladder tumors or early detection of recurrence after bladder tumor treatment.At present,follow-up examinations for patients with bladder cancer include regular cystoscopy,transabdominal color Doppler ultrasound and urine exfoliative cell.Although there are advanced flexible fiberoptic endoscopes,most hospitals still use rigid cystoscopy at present.After all,endoscopic examination is an invasive operation,especially thepatients who have been followed up many times.The economic burden is also great.Cystoscopy and transabdominal color Doppler ultrasound are widely used in preoperative diagnosis and postoperative follow-up of bladder cancer in China.All the time,the former is the gold standard for diagnosis of bladder cancer,but for invasive examination,patients feel uncomfortable,while the latter is a non-invasive examination,and with the improvement and development of ultrasonic instruments,the accuracy of the diagnosis of bladder cancer by abdominal color Doppler ultrasound is greatly improved.In this study,ultrasonography and cystoscopy were compared in the diagnosis of bladder tumors by assessing the sensitivity and specificity,as well as the positive rate of diagnosis in different numbers,positions,and size of tumors.The purpose of this study is to evaluate the diagnostic value of ultrasonography in bladder tumors.Methods: A retrospective analysis was made of 182 patients with bladder tumor in the Department of Urology in Dalian Medical university from June 2016 to December 2017 with bladder tumor resection.Among them,163 patients were eligible for this study.In the 163 cases of the patients,there were 158 cases with clear tumor,and there are 5 cases with no clear bladder tumor was seen in the operation,but the biopsy results were malignant tumor.The postoperative pathology of the 163 patients was urothelial neoplasm.All patients underwent cystography and cystoscopy before operation.Both preoperative color ultrasound and cystoscopy were examined by the same physician.According to surgical records and postoperative pathology,color Doppler ultrasound or cystoscopy found the tumor and consistent with the postoperative pathology was correct,the suspicious tumor is also recorded as consistent.No tumor was found to be inconsistent.The correct rate is equal to the total number of tumors found by surgery divide by conforming number.Specificity is equal to the total number of tumors not found by surgery divide by not conforming number.The coincidence rate of color ultrasound and cystoscope in different position,maximum diameter,single or multiple bladder tumor were calculated respectively.The comparison of intergroup rate was analyzed by chi-square test,and the difference was statistically significant with P value less than 0.05.The coincidence rate oftransabdominal ultrasound and cystoscopy for diagnosis of tumor was statistically analyzed,and the correlation between missed diagnosis rate and tumor quantity,size and position was analyzed.Results: The average age of 163 patients was 64.75(34-89)years.There were128 men and 35 women.In the 163 patients,the overall sensitivity and specificity of color doppler ultrasonography were 88.61% and 60%,and the overall sensitivity and specificity of cystoscopy were 92.41% and 80% respectively.According to the surgical records,there were 120 cases of single bladder tumor and 38 cases of multiple bladder tumors in 158 patients with clear tumors.There were41 cases with the largest diameter <10mm bladder tumor,97 cases in 10 ~ 20 mm,and20 cases of >20 mm.The patients with bladder tumor located on the lateral wall,bottom,top and neck of the bladder were 95?86?23 and 14 respectively.There were 106 cases of single tumor and 34 cases of multiple tumors detected by color Doppler ultrasound.The number of bladder tumor located on the lateral wall,bottom,top and neck of the bladder were 85?83?18 and 12 respectively.There were29 cases were detected at <10 mm in maximum diameter,91 cases at 10-20 mm,and20 cases at> 20 mm.There were 113 single bladder tumors and 33 multiple tumors were detected by cystoscopy.The number of bladder tumor located on the lateral wall,bottom,top and neck of the bladder were 94?82?16 and 7 respectively.There were 38 cases were detected at <10 mm in maximum diameter,89 cases at 10-20 mm,and 19 cases at> 20 mm.The results of statistical analysis showed that there was no statistical different between cystoscopy and transabdominal ultrasound in the diagnosis of the single or multiple tumors.There was no statistical difference between color Doppler and cystoscopy in the diagnosis of bladder tumor with the maximum diameter >10 mm(P >0.05).In the diagnosis of bladder tumors with the largest diameter <10mm,the compliance rate of cystoscopy and transabdominal ultrasonography were 92.68% and70.73%,the difference between cystoscopy and color Doppler was statistically significant(P <0.05).The compliance rate of cystoscopy and color Doppler were 50%and 85.71% for the tumors of bladder neck.There was statistically different between cystoscopy and transabdominal ultrasound in the diagnosis of tumors of bladder neck(P <0.05).The compliance rate of cystoscopy and transabdominal ultrasound on the side wall of the bladder were 95.79% and 89.47% respectively.There was statistically different between cystoscopy and transabdominal ultrasound in the diagnosis of tumors located at the side wall(P <0.05).There was no statistical different between cystoscopy and transabdominal ultrasound in the diagnosis of the tumors located at top and the bottom of the bladder(P >0.05).Conclusion: The overall sensitivity and specificity of color Doppler ultrasound for bladder tumor is lower than cystoscope.There was no difference in the diagnosis of single or multiple bladder tumors between color Doppler ultrasound and cystoscopy.The compliance rate of cystoscopy was more accurate than the abdominal color Doppler in the diagnosis of bladder tumor located at the side wall of the bladder.The compliance rate of the abdominal color Doppler was more accurate than cystoscopy in the diagnosis of tumor tumors of bladder neck.There was no difference between cystoscopy and color Doppler in compliance rate of tumors located at the top and the bottom of the bladder.There was no difference in the tumors with the maximum diameter >10 mm.The compliance rate of cystoscopy was more accurate than abdominal color Doppler in the diagnosis of the maximum diameter <10 mm.The missed diagnosis of ultrasound is correlated with the size and location of bladder tumor,and has no significant correlation with the number. |
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