After taking a history and performing the appropriate physical exam, the urologist will need to use ancillary tests to obtain further evidence to confirm the diagnosis of bladder cancer.
Ultrasound As a non-invasive and simple test, ultrasound is the first choice for primary screening. Transabdominal ultrasound has been reported to have a sensitivity of 63%-98% and a specificity of 99% for the diagnosis of bladder cancer. However, as with other imaging tests, ultrasonography cannot diagnose bladder cancer in situ.
Urological plain films and intravenous urography Although always considered routine, the need for this test at the time of initial diagnosis is now questioned because of the low amount of important information obtained.
CT/MRI is mostly used to determine the stage of the tumor.
Cystoscopy is the most reliable method of diagnosing bladder cancer and is the “gold standard”. Cystoscopy can clarify the number, size, shape, location and surrounding abnormalities of bladder tumors, and biopsy can be performed on tumors and suspicious lesions to clarify the pathological diagnosis.
Diagnostic transurethral resection (TUR) If imaging examination reveals tumor-like lesions in the bladder, cystoscopy can be omitted and diagnostic TUR can be performed directly. this can achieve 2 purposes: one is to remove the tumor, and the other is to clarify the pathological diagnosis and grading and staging of the tumor to provide a basis for further treatment as well as to judge the prognosis.
The Chinese guidelines for the diagnosis and treatment of urological diseases (2014) recommend that cystoscopy and pathological biopsy, or diagnostic TUR and pathological examination, should be performed in all patients with suspected bladder cancer.