Prospective Comparison of Computerized Tomography and Excretory Urography in the Initial Evaluation of Asymptomatic Microhematuria

Sears, Christine L. Gray; Ward, John F.; Sears, Stephen T.; Puckett, Michael F.; Kane, Christopher J.; Amling, Christopher L.

doi:10.1016/s0022-5347(05)64167-5

Cited by 117 publications

(18 citation statements)

References 12 publications

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“…The presence of haematuria (either macroscopic or microscopic) warrants investigation of both the upper and lower urinary tracts. It was suggested that the two imaging methods of the upper tracts (IVU and US) could be replaced by one CTU scan, which is more sensitive [9]. The present study showed that, with the correct protocol, CTU can accurately detect bladder tumours in patients with haematuria, and should be considered as a possible single noninvasive screening investigation.…”

Section: Discussionmentioning

confidence: 76%

Computed tomography urography for diagnosing bladder cancer

et al. 2006

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RESULTSThe prevalence of bladder tumours was 24%; when CTU was compared with the histopathological findings, there was one false-positive and three false-negative diagnoses, indicating a sensitivity of 0.93 and a specificity of 0.99, with a 0.98 positive and 0.97 negative predictive value for detecting bladder cancer. A review of the three falsenegative cases showed that one was missed on original CTU reporting, the second had the appearance of prostate cancer on CTU and the third was a squamous metaplasia. CONCLUSIONSCTU is an accurate method of detecting bladder tumours in the present patients, and is reliable and accurate for assessing the bladder. Our results support the use of CTU as a first-line screening tool for this high-risk group, the use of which will obviate the need for flexible cystoscopy in patients with a negative CTU and allow those with an obvious tumour to be referred directly for rigid cystoscopy and resection. The remaining patients should be referred for flexible cystoscopy. Such a pathway would accelerate patient assessment by using fewer tests and provide a true 'one-stop' clinic, allowing a comprehensive evaluation with a single test for the upper and lower urinary tract. KEYWORDS macroscopic haematuria, haematuria, bladder cancer, cystoscopy, virtual cystoscopy, CT urography OBJECTIVETo evaluate the use of computed tomography urography (CTU) for diagnosing bladder tumours in patients with macroscopic haematuria and aged > 40 years. PATIENTS AND METHODSIn all, 200 consecutive patients attending a fast-track haematuria clinic were assessed using 'same-day' CTU and flexible cystoscopy. Patients were aged > 40 years and had macroscopic haematuria with no urine infection. CTU studies were reported by one uroradiologist and scored on a 3-point scale to quantify the probability of bladder cancer. All flexible cystoscopies were performed by the same cystoscopist with no knowledge of the findings of CTU, and scored using a 3-point scale. Cystoscopy, pathological findings and CTU were then compared.

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Section: Discussionmentioning

confidence: 76%

Computed tomography urography for diagnosing bladder cancer

et al. 2006

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“…A recent meta‐analysis of published literature on CT urography highlights a pooled sensitivity 96% and a pooled specificity of 99%[16]. This compares very favourably with the reported sensitivities for excretory urography, which are in the range 50–60%[17,18]. An additional technological advance in the past three decades has been improvements in ureteroscopy (URS).…”

Section: Discussionmentioning

confidence: 83%

Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005

Raman¹,

Messer²,

Sielatycki³

et al. 2010

BJU International

316

200

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Study Type – Prognosis (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Upper‐tract urothelial carcinoma (UTUC) is a relatively uncommon urological malignancy with survival and outcomes data largely determined from single‐centre series which can be limited by relatively small case numbers. Through review of a large population based cohort, this study provides valuable information regarding epidemiological and survival patterns for over 13,000 patients with UTUC diagnosed over the past three decades. OBJECTIVE • To evaluate epidemiological and survival patterns of upper‐tract urothelial carcinoma (UTUC) over the past 30 years through a review of a large, population‐based database. PATIENTS AND METHODS • Data from the Surveillance, Epidemiology and End Results (SEER) database from 1973 to 2005 were reviewed in 10‐year increments to evaluate disease trends. • Univariate and multivariate survival analyses identified prognostic variables for outcomes. RESULTS • In total, 13 800 SEER‐registered cases of UTUC were included. The overall incidence of UTUC increased from 1.88 to 2.06 cases per 100 000 person‐years during the period studied, with an associated increase in ureteral disease (0.69 to 0.91) and a decrease in renal pelvic cancers (1.19 to 1.15). • The proportion of in situ tumours increased from 7.2% to 31.0% (P < 0.001), whereas local tumours declined from 50.4% to 23.6% (P < 0.001). • There was no change in the proportion of patients presenting with distant disease. • In multivariate analysis, increasing patient age (P < 0.001), male gender (P < 0.001), black non‐Hispanic race (P < 0.001), bilateral UTUC (P= 0.001) and regional/distant disease (P < 0.001) were all associated with poorer survival outcomes. CONCLUSIONS • The incidence of UTUC has slowly risen over the past 30 years. • Increased use of bladder cancer surveillance regimens and improved abdominal cross‐sectional imaging may contribute to the observed stage migration towards more in situ lesions. • Although pathological disease characteristics impact cancer outcomes, certain sociodemographic factors also appear to portend worse prognosis.

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“…CT urography has high diagnostic accuracy for urothelial cancers compared with excretory urography [29,31–33] but has the disadvantage of a higher radiation exposure of 20.1 mSv compared with 11.9 mSv for excretory urography [34]. The improvement in diagnostic capabilities outweighs the use of increased radiation dose for CT urography in this population group with a prevalence of UUT and LUT cancer of 25% [34].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

et al. 2011

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What ' s known on the subject? and What does the study add?Haematuria clinics with same day imaging and fl exible cystoscopy are an effi cient way for investigating patients with haematuria. The principal role of haematuria clinics with reference to bladder cancer is to determine which patients are ' normal ' and may be discharged, and which patients are abnormal and should undergo rigid cystoscopy. It is well recognised that CT urography offers a thorough evaluation of the upper urinary tract for stones, renal masses and urothelial neoplasms but the role of CT urography for diagnosing bladder cancer is less certain. The aim of the present study was to evaluate the diagnostic accuracy of CT urography in patients with visible haematuria aged > 40 years and to determine if CT urography has a role for diagnosing bladder cancer.This study shows that the optimum diagnostic strategy for investigating patients with visible haematuria aged > 40 years with infection excluded is a combined strategy using CT urography and fl exible cystoscopy. Patients positive for bladder cancer on CT urography should be referred directly for rigid cystoscopy and so avoid fl exible cystoscopy. The number of fl exible cystoscopies required therefore may be reduced by 17%. The present study also shows that the diagnostic accuracy of voided urine cytology is too low to justify its continuing use in a haematuria clinic using CT urography and fl exible cystoscopy. OBJECTIVES• To evaluate and compare the diagnostic accuracy of computed tomography (CT) urography with fl exible cystoscopy and voided urine cytology for diagnosing bladder cancer.• To evaluate diagnostic strategies using CT urography as: (i) an additional test or (ii) a replacement test or (iii) a triage test for diagnosing bladder cancer in patients referred to a hospital haematuria rapid diagnosis clinic. PATIENTS AND METHODS• The clinical cohort consisted of a consecutive series of 778 patients referred to a hospital haematuria rapid diagnosis clinic from 1 March 2004 to 17 December 2007. Criteria for referral were at least one episode of macroscopic haematuria, age > 40 years and urinary tract infection excluded. Of the 778 patients, there were 747 with technically adequate CT urography and fl exible cystoscopy examinations for analysis.• On the same day, patients underwent examination by a clinical nurse specialist followed by voided urine cytology, CT urography and fl exible cystoscopy. Voided urine cytology was scored using a 5-point system. CT urography was reported immediately by a uroradiologist and fl exible cystoscopy performed by a urologist. Both examinations were scored using a 3-point system: 1, normal; 2, equivocal; and 3, positive for bladder cancer.• The reference standard consisted of review of the hospital imaging and histopathology databases in December 2009 for all patients and reports from the medical notes for those referred for rigid cystoscopy. Follow-up was for 21 -66 months. RESULTS• The prevalence of bladder cancer in the clinical cohort was 20% (156/77...

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Prospective Comparison of Computerized Tomography and Excretory Urography in the Initial Evaluation of Asymptomatic Microhematuria

Cited by 117 publications

References 12 publications

Computed tomography urography for diagnosing bladder cancer

Computed tomography urography for diagnosing bladder cancer

Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

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