血尿可分为肉眼血尿和镜下血尿，可能由多种潜在病因引起。目前，在血尿的情况下，膀胱镜检术是筛查整个膀胱恶性肿瘤的标准诊断工具。本系统评价的目的是确定膀胱镜检术（与其他检测方法如计算机断层扫描、尿液生物标志物和尿液细胞学等）在检测成年人膀胱癌方面的诊断准确性。根据Cochrane诊断试验准确度系统性综述和系统综述与Meta分析（PRISMA）诊断试验准确度研究扩展的检查清单，对文献进行了系统综述。通过Ovid搜索了MEDLINE、Embase、Cochrane CENTRAL和Cochrane CDSR数据库，截至2022年7月13日。人群包括出现肉眼血尿或镜下血尿的患者，但没有先前的泌尿系统癌症。两名评审员独立筛选所有文章，搜索检索到的文章的参考文献目录，并进行数据提取。使用Diagnostic Accuracy Studies (QUADAS-2)评估偏倚风险。总体而言，共有9项研究纳入了定性分析。其中，有7项纳入的试验涵盖了将膀胱镜检术与放射学成像进行比较的应用。总体而言，膀胱镜检术的敏感性为87%至100%，特异性为64%至100%，阳性预测值为79%至98%，阴性预测值在98%至100%之间。两项试验比较了增强或气体膀胱镜检术与传统膀胱镜检术。传统白光膀胱镜检术的敏感性总体范围为47%至100%，特异性为93.4%至100%。在血尿背景下，膀胱镜检术对于膀胱癌的检测的真实准确性尚未广泛研究，导致关于它在血尿患者中的表现的数据不一致。与成像技术相比，只有少数试验前瞻性评估了膀胱镜检术的诊断性能，确认了膀胱镜检术的非常高准确性，超过任何其他成像检查的诊断价值。我们综述了用于检测出现血尿（尿液中有血）的成年人的膀胱癌的测试证据。最常用的测试是膀胱镜检术，它仍然是诊断膀胱癌的当前标准。版权所有©2023作者。由Elsevier B.V.出版。保留所有权利。

Haematuria can be macroscopic (visible haematuria [VH]) or microscopic (nonvisible haematuria [NVH]), and may be caused by a number of underlying aetiologies. Currently, in case of haematuria, cystoscopy is the standard diagnostic tool to screen the entire bladder for malignancy.The objective of this systematic review is to determine the diagnostic test accuracy of cystoscopy (compared with other tests, eg, computed tomography, urine biomarkers, and urine cytology) for detecting bladder cancer in adults.A systematic review of the literature was performed according to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for diagnostic test accuracy studies' checklist. The MEDLINE, Embase, Cochrane CENTRAL, and Cochrane CDSR databases (via Ovid) were searched up to July 13, 2022. The population comprises patients presenting with either VH or NVH, without previous urological cancers. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).Overall, nine studies were included in the qualitative analysis. Seven out of nine included trials covered the use of cystoscopy in comparison with radiological imaging. Overall, sensitivity of cystoscopy ranged from 87% to 100%, specificity from 64% to 100%, positive predictive value from 79% to 98%, and negative predictive values between 98% and 100%. Two trials compared enhanced or air cystoscopy versus conventional cystoscopy. Overall sensitivity of conventional white light cystoscopy ranged from 47% to 100% and specificity from 93.4% to 100%.The true accuracy of cystoscopy for the detection of bladder cancer within the context of haematuria has not been studied extensively, resulting in inconsistent data regarding its performance for patients with haematuria. In comparison with imaging modalities, a few trials have prospectively assessed the diagnostic performance of cystoscopy, confirming very high accuracy for cystoscopy, exceeding the diagnostic value of any other imaging test.Evidence of tests for detecting bladder cancer in adults presenting with haematuria (blood in urine) was reviewed. The most common test used was cystoscopy, which remains the current standard for diagnosing bladder cancer.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.