Bladder Cancer: Diagnostic Tests

Mandatory medical device diagnostics.

  • Abdominal ultrasonography (ultrasound examination of abdominal organs) including small pelvis – for basic diagnosis [detection of larger tumors and urinary retention if necessary]; also for follow-upNote:
    • Abdominal ultrasonography is considered sufficient for the initial finding of non-muscle-invasive bladder cancer (NMIBC) – no imaging workup of the upper urinary tract should be performed.
    • Imaging of the upper urinary tract should be performed, however, if the tumor is located in the trigone region and/or if there are multiple tumors and/or high-grade tumors.

    Notes on the examination: when examining the urinary bladder should be well filled (250-300 ml). In this way, irregularities of the urinary bladder surface or exophytic tumors can be well depicted.When examining the kidneys, look for an existing urinary stasis or a tumor in the upper urinary tract.

  • Urethrocystoscopy (urethral and bladder endoscopy) with quadrant biopsy (primary diagnosis with white light cystoscopy; if necessary. using hexaminolevulinate fluorescence cystoscopy for better detection of carcinoma in situ, CIS) – for accurate dignity determination [method of choice]Notes on examination: Improve detection rate “find rate”), recurrence- and progression-free survival through photodynamic diagnosis (PDD; specific staining of urinary bladder tumors using a dye introduced into the urinary bladder that allows improved diagnosis of urinary bladder tumors) and “narrow band imaging” (NBI; variant of endoscopy that uses blue and green light to improve surface visualization of the mucosa (mucous membrane): hypervascularized (“vascular”) tissue and pathologic (“pathological”) vascular formations are shown in high contrast) Note: After exclusion of a bladder tumor by cystoscopy as a cause of micro- or macrohematuria or a positive cytology, a clarification of the upper urinary tract should be performed.

Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.

  • Computed tomography (CT) of the pelvis (pelvic CT) with CT urography:
    • First procedure for diagnosis of the upper urinary tract in the clarification of hematuria (blood in the urine) in people over 45 years of age.
    • In patients with muscle-invasive bladder carcinoma (tumor staging).
    • In suspected metastasis (formation of daughter tumors) (tumor staging).
  • Computed tomography of the thorax/chest (thoracic CT):
    • If pulmonary metastases are suspected
    • In patients with muscle-invasive carcinoma of the urinary bladder.
  • Computed tomography of the skull (cranial CT; cranial CT) – performed only in the presence of clinical symptoms and/or abnormal diagnostic findings.
  • Magnetic resonance imaging of the pelvis (pelvic MRI) (alternative to pelvic CT) – in case of suspected metastasis; also for follow-up.
  • X-ray of the thorax (X-ray thorax / chest), in two planes – in advanced tumors; also for follow-up care.

Recurrence diagnostics

  • White light cystoscopy (mainly due to its widespread availability) – tumor follow-up of non-muscle-invasive bladder cancer (NMIBC) [gold standard]Note: The method has weaknesses in the detection of smallest papillary tumors and flat lesions, especially carcinoma in situ (CIS). In the case of high-grade tumors, cytology has a high specificity (probability that healthy individuals who do not suffer from the disease in question are also identified as healthy in the test).Examination intervals as part of follow-up: 3 months after initial diagnosis/TURB, then annually up to and including the fourth year.