Accuracy of cystoscopy in predicting histologic features of bladder lesions.
OBJECTIVE
To correlate individual endoscopist impressions of the nature (benign/malignant) of a urothelial lesion and, in the case of malignancy, "clinical" grade and stage of bladder lesions with the histologic findings after transurethral biopsy/resection. Furthermore, we compared the assessments of trainees and experienced urologists.


METHODS
We considered 146 patients submitted to cystoscopy and transurethral excision of tumors or biopsy of suspect regions. Clinical and pathologic diagnoses were compared, and the agreement between reports was assessed by calculating kappa statistics.


RESULTS
Complete agreement between the cystoscopic and histologic diagnoses was found in 131 of 146 cases. Both specialists and trainees had a tendency to overdiagnose bladder cancer, and they were not effective in predicting the precise stage: complete agreement with the pathologic stage was observed in 66.1% and 64.5% of cases, respectively. Grade was assessed correctly in 55.1% and 54.3% of the cases. The two teams of surgeons expressed complete agreement in the prediction of stage in 78.7% of cases (kappa 0.658) and of grade in 73.2% of cases (kappa 0.584).


CONCLUSIONS
Our study confirms the diagnostic value of cystoscopy, given the high recognizability of the malignant nature of a lesion by both specialists and trainees. However, cystoscopy is less satisfactory for the characterization of the stage and grade of a cancer. The comparative assessment of the endoscopic and pathologic findings could prove useful to assess the effectiveness of training in endoscopy.
Mitropoulos
D
D
First Department of Urology, Athens Medical School, Athens, Greece. dmp@otenet.gr
Kiroudi-Voulgari
A
A
Nikolopoulos
P
P
Manousakas
T
T
Zervas
A
A
D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis*; D002983:Clinical Competence; D003558:Cystoscopy; D006115:Greece; D006801:Humans; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*; D014572:Urology / Q000193:education