Page 1 - CUA 2020_Onco_Testis-Kidney-Urothelial

2020 CUA ABSTRACTS

Podium Session 4: Oncology – Other

POD-4.1 the predetermined reference standard (i.e., bladder cancer detection with
Diagnostic test accuracy for ultrasound, computed tomography histology or accepted clinical gold standard diagnosis) with resultant
urography, and cytology in the detection of bladder cancer: index test outcomes. Equivocal outcomes were deemed positive findings,
Results from a global, multicenter analysis as they prompted further workup. Test adequacy was determined by indi-
1,2
1,2
1,2
3
Taeweon Lee , Miles Mannas , Peter C. Black , Mark Assmus , Tim vidual collaborators and only those considered adequate were included
6
3
5
4
Wollin , Sinan Khadhouri , Kevin Gallagher , Kenneth MacKenzie , Taimur in the analysis.
Shah , Chuanyu Gao , Sacha Moore , Eleanor Zimmermann , Eric Edison , Results: Bladder cancer detection rate was 17.9% (n=1951). Median age
11
9
10
7
8
12
13
Matthew Jefferies , Arjun Nambiar , Matthew Nielsen , John McGrath , was 72 years. Prevalence rate was higher in men (21.8%, n=1485) vs.
6
14
Veeru Kasivisvananthan 15 women (11.3%, n=463). Nine patients did not receive gender alloca-
1 Department of Urologic Sciences, University of British Columbia, tion, three of whom were diagnosed with bladder cancer. The rate was
Vancouver, BC, Canada; Vancouver Prostate Centre, Vancouver General 22.4% (n=1598) in patients with visible hematuria (VH), 5.23% (n=165) in
2
3
Hospital, Vancouver, BC, Canada; Division of Urology, University of non-visible hematuria (NVH), and 30.6% (n=188) in no hematuria (NH).
Alberta, Edmonton, AB, Canada; Department of Urology, Aberdeen Royal Ultrasound (USS) and computed tomography urography (CTU) showed
4
5
Infirmary, Aberdeen, United Kingdom; Department of Urology, Western similar performance in the detection of bladder cancer. Sensitivity of CTU
6
General Hospital, Edinburgh, United Kingdom; Department of Urology, was greater than USS in NVH, albeit with lower number of tests performed
Freeman Hospital, Newcastle, United Kingdom; Department of Surgery and (Table 1). For each imaging modality, the test performance varied by whether
7
Cancer, Charing Cross Hospital, London, United Kingdom; Department hematuria was visible or not. The sensitivity and overall performance of
8
of Urology, Peterborough City Hospital, Peterborough, United cytology alone was poor but when used in combination with USS in patients
Kingdom; Department of Urology, Wrexham Maelor Hospital, Wrexham, with either VH or NVH, had a higher overall negative predictive value
9
10
United Kingdom; Department of Urology, Weston General Hospital, than CTU alone.
11
Weston-super-Mare, United Kingdom; Department of Urology, North Conclusions: Both USS and CTU ruled out bladder cancer with high accu-
Middlesex Hospital, London, United Kingdom; Department of Urology, racy. These results suggest bladder biopsy is warranted if USS or CTU is
12
13
Morriston Hospital, Swansea, United Kingdom; University of North suspicious for the presence of a bladder tumor. Further analysis of the
Carolina, Dept. of Urology, Chapel Hill, North Carolina, United States; IDENTIFY dataset will determine which patients can be classified as low-
14 Department of Urology, University of Exeter Medical School, Exeter, risk, with the possibility that these patients could avoid flexible cystoscopy
15
United Kingdom; Department of Urology, University College London, if upper tract imaging is negative.
London, United Kingdom; The IDENTIFY Study Group
Introduction: We evaluated the diagnostic performance of tests used in
bladder cancer detection in a global study of patients referred to secondary
care for suspected urinary tract cancer.
Methods: The IDENTIFY group prospectively reviewed 10 896 patients
(27 countries). Those with previous urological malignancy were excluded.
Diagnostic test (e.g., cystoscopy, imaging) performance was assessed using
POD-4.1. Table 1. The diagnostic test performance of ultrasound (USS), computed tomography urography (CTU), and
cytology in bladder cancer detection
n Accuracy Sensitivity Specificity Positive Negative
[(TP+TN)/n] predictive value predictive value
USS Overall 5993 89.4% 78.3% 92.3% 72.1% 94.3%
In VH 3671 88.2% 78.7% 91.5% 76.9% 92.3%
In NVH 1953 95.2% 59.0% 97.6% 62.1% 97.3%
CTU Overall 4007 89.8% 77.2% 92.9% 72.6% 94.3%
In VH 3177 89.7% 76.8% 93.1% 74.8% 93.8%
In NVH 696 94.3% 81.5% 95.3% 59.5% 98.4%
Cytology Overall 3742 83.4% 56.4% 88.7% 49.4% 91.2%
In VH 2439 81.9% 58.6% 87.9% 55.7% 89.1%
In NVH 1132 89.1% 52.4% 91.2% 26.0% 97.0%
USS + cytology (VH + NVH) 2176 83.7% 84.8% 83.7% 50.7% 96.3%
CTU + cytology (VH + NVH) 1586 81.1% 84.4% 80.4% 47.6% 96.1%
Accuracy was determined by dividing the sum of true positive (TP) and true negative (TN) by the total (n).
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S37
© 2020 Canadian Urological Association