Comparative Effectiveness of Imaging Modalities for the Diagnosis of Upper and Lower Urinary Tract Malignancy: A Critically Appraised Topic

Rationale and Objectives: The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of upper and lower/bladder urinary tract cancer, transitional cell carcinoma (TCC). Methods: A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome (PICO) method comparing computed tomography (CT) urography, magnetic resonance (MR) urography, excretory urography, and retrograde urography in the detection of TCC of the upper urinary tract. The same methods were used to compare CT cystography, MR cystography, and ultrasonography in the diagnosis of bladder cancer. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies. Results: The retrieved sensitivity/specificity for the detection of TCC of upper urinary tract for CT urography, MR urography, excretory urography, and retrograde urography were 96%/99%, 69%/97%, 80%/81%, and 96%/96%, respectively. For detecting bladder cancer, the retrieved sensitivity/specificity for CT cystography, MR cystography, and ultrasonography were 94%/98%, 91%/95%, and 78%/96%, respectively. Conclusions: CT urography is the best imaging technique for confirming or excluding Malignancy in the upper urinary tract, whereas CT cystography has the best diagnostic performance for diagnosing bladder cancer.