Could Nonenhanced Computer Tomography Suffice as the Imaging Study of Choice for the Screening of Asymptomatic Microscopic Hematuria?

Janssen, Karmon; Nieves-Robbins, Neris; Echelmeier, Trevor B.; Nguyen, David K.; Baker, Karen

doi:10.1016/j.urology.2018.07.013

Cited by 6 publications

(15 citation statements)

References 17 publications

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“…6 Published papers also show that MH can occur due to urothelial cancer, including bladder and upper tract malignancy. 12,13 The present study contained some methodical differences from the above-mentioned studies. First, we included in the study only the patients who had undergone a complete urological evaluation so that we would not miss any malignant lesion.…”

Section: Ta B L E 2 Multiple Logistic Regression Analysis Results and Odds Ratiosmentioning

confidence: 83%

Individual‐risk‐score for urinary tract malignancy in patients with microscopic hematuria

et al. 2021

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Microscopic hematuria (MH) is defined as 3 or more red blood cells per high-power field (RBC/HPF) on microscopic evaluation. 1 It may occur due to the patient's nephrologic, gynecologic, and urologic conditions. The urological conditions include nephrolithiasis, benign prostatic hyperplasia, urinary tract infection, urethral strictures, and rarely, urinary tract malignancies. 2 Indeed, urinary tract malignancy has been diagnosed in only 3% of the patients evaluated for MH. 3,4 The previous MH evaluation algorithm suggested evaluation using cystoscopy and radiological imaging for nearly all patients with MH. This, however, may lead to an increase in the number of unnecessary invasive and costly diagnostic procedures conducted. 5 Therefore, the American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction's (SUFU) panelists stated that there was a need for updated, evidence-based guideline recommendations for the evaluation of patients with MH that limit the unnecessary adverse events and costs associated with the diagnostic procedures for patients with a low risk for

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Section: Ta B L E 2 Multiple Logistic Regression Analysis Results and Odds Ratiosmentioning

confidence: 83%

Individual‐risk‐score for urinary tract malignancy in patients with microscopic hematuria

et al. 2021

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“…Therefore, a total of 20 studies 2,4,5,21-37 met the inclusion criteria, 15 2,5,21-26,29,32-37 of which reported on diagnostic test characteristics of the imaging modalities, and 5 4,27,28,30,31 of which reported on outcomes identified as important to the AUA hematuria guideline, 3 such as cost, but out of scope for the current publication. Of the 15 studies reporting on diagnostic test characteristics, 6 2,21-25 were included in the final quantitative synthesis and 9 5,26,29,32-37 were not used in the meta-analysis or to calculate post-test probabilities as they did not include sufficient detail to calculate sensitivities, specificities, or likelihood ratios. A summary of the risk of bias assessment for the 6 studies included within the quantitative analysis can be found in supplementary Appendix 2 (https://www.jurology.com) and GRADE profiles can be found in supplementary Appendix 3 (https://www.jurology.com).…”

Section: Resultsmentioning

confidence: 99%

“…Based off of the pooling of 6 sensitivities and specificities, CTU detection of UTUC or RCC resulted in sensitivities and specificities of 94.2% (95%CI, 83.8%-98.1%) and 99.1% (95%CI, 96.6%-99.8%), respectively (Table 1). 2,21-23 The certainty of evidence for this pooling was low for both sensitivity and specificity (supplementary Appendix 3, https://www.jurology.com). The certainty of evidence was based on a very serious risk of bias across the included studies, but no further downgrading.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic Imaging in the Evaluation of Asymptomatic Microhematuria: Systematic Review and Meta-analysis

Taylor

Souter²,

Barocas

et al. 2023

Journal of Urology

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Purpose: Microhematuria is a highly prevalent condition with a low associated risk of urothelial and upper tract malignancy. The AUA Guidelines recently changed recommendations for imaging favoring renal ultrasound for low-and intermediate-risk patients with microhematuria. We summarize the diagnostic test characteristics of computed tomography urography, renal ultrasound, and magnetic resonance urography in comparison with surgical pathology for the diagnosis of upper urinary tract cancer in microhematuria and gross hematuria patients. Materials and Methods: This study is a systematic review and meta-analysis using PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) guidelines from evidence collected for the 2020 AUA Microhematuria Guidelines report, including studies assessing imaging following diagnosis of hematuria published from January 2010 through December 2019.Results: The search identified 20 studies which reported the prevalence of malignant and benign diagnoses in relation to imaging modality, of which 6 were included in the quantitative analysis. For the detection of renal cell carcinoma and upper urinary tract carcinoma in patients with microhematuria and gross hematuria, computed tomography urography had a sensitivity of 94% (95% CI, 84%-98%) and a specificity of 99% (95%CI, 97%-100%) with a certainty of evidence rating of very low and low, respectively when 4 studies were pooled. In comparison, ultrasound demonstrated a sensitivity ranging from 14%-96% (low certainty of evidence) and a specificity of 99%-100% in 2 studies (moderate certainty of evidence), while magnetic resonance urography demonstrated a sensitivity of 83% and specificity of 86% in 1 study with a low certainty of evidence. Conclusions: In a limited data set for each individual imaging modality, computed tomography urography appears the most sensitive imaging modality for the diagnostic evaluation of microhematuria. Future studies will be needed to evaluate the clinical and health system financial impacts of the change in guideline recommendations from computed tomography urography to renal ultrasound in evaluating low-and intermediate-risk patients with microhematuria.

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“…In a retrospective study of 475 patients aged 18 to 96 years who underwent CTU for asymptomatic microscopic hematuria, unenhanced CT had a negative predictive value of over 95% and a specificity of over 89% for the characterization of upper urinary tract findings as normal, benign, or suspicious. 16 Contrast-enhanced images were recommended in only 16% of patients. Four of 5 upper urinary tract malignancies diagnosed in patients aged 54 to 78 years were detected on the unenhanced images.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Yield of CT Urography in the Workup of Hematuria With Negative Cystoscopy

2020

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Purpose: To determine the diagnostic yield of computed tomography urography (CTU) in patients evaluated for hematuria with negative cystoscopy and to assess the added value of CTU when compared with ultrasound (US) in this patient population. Methods: A retrospective study was conducted of patients who underwent CTU within 12 months of negative cystoscopy for workup of hematuria at our institution from January 2016 to December 2017. Computed tomography urography findings were recorded and compared to clinical diagnoses to determine diagnostic yield. Computed tomography urography and US findings were compared in patients who underwent both examinations. Patient characteristics (age, sex, smoking history, and hematuria subtype) were reported. Results: A total of 657 patients met the inclusion criteria, including 108 patients aged 50 years and younger. No cause for hematuria was identified in 41% of patients overall and 58% of patients aged 50 years and younger. The most common diagnoses were benign prostatic hyperplasia and urolithiasis, accounting for 25% and 21% of patients, respectively; 0.6% of patients were diagnosed with an upper urinary tract malignancy, all older than 50 years. Although US was superior or equal to CTU for diagnosis in 83% of patients who underwent both examinations, US had a 0% sensitivity for detection of upper urinary tract malignancy. Conclusion: The low diagnostic yield of CTU and low prevalence of upper urinary tract malignancy in patients evaluated for hematuria with negative cystoscopy, particularly those aged 50 years and younger, call into question the appropriateness of multiphasic CTU as a first-line imaging modality in this population.

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Could Nonenhanced Computer Tomography Suffice as the Imaging Study of Choice for the Screening of Asymptomatic Microscopic Hematuria?

Cited by 6 publications

References 17 publications

Individual‐risk‐score for urinary tract malignancy in patients with microscopic hematuria

Individual‐risk‐score for urinary tract malignancy in patients with microscopic hematuria

Diagnostic Imaging in the Evaluation of Asymptomatic Microhematuria: Systematic Review and Meta-analysis

The Diagnostic Yield of CT Urography in the Workup of Hematuria With Negative Cystoscopy

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