Contrast-enhanced ultrasound in the diagnosis of neoplastic lesions of the urinary bladder.

Introduction: Cystoscopy remains the gold standard of diagnosis and follow-up for bladder cancer (BC); however, it is an invasive procedure associated with discomfort and potential complications. Contrastenhanced ultrasound (CEUS) emerges as an alternative, utilizing real-time assessment of tumor vascularization and perfusion. The aim of this systematic review was to evaluate its diagnostic performance for BC detection. Material and methods: MEDLINE (PubMed), Scopus, Web of Science Core Collection and Embase databases were queried through July, 2024. We included studies reporting on the diagnostic accuracy of CEUS for the detection of BC. Results: Out of 883 individual records, we identified 6 reports of prospective and retrospective studies, comprising 894 patients. The included studies indicate that CEUS demonstrates high diagnostic sensitivity, and specificity in discriminating malignant from benign bladder tumors. Moreover, CEUS has been shown promising performance in the preoperative prediction of tumor grade and stage, offering diagnostic capabilities comparable to well-established non-invasive imaging techniques. Conclusions: Our findings support the utilization of CEUS as adjunct to existing BC diagnostic protocols. It represents an alternative for BC diagnosis and could benefit patients contraindicated for conventional imaging modalities or at high-risk of cystoscopy-related complications. Scant amount of standardized, large-scale, prospective, comparative investigations are available, thus further research is necessary to validate the clinical utility of CEUS in BC detection.