Accuracy of ultrasound vs computed tomography scan for upper urinary tract malignancies and development of a risk-based diagnostic algorithm for haematuria in a UK tertiary centre

Abstract

Accuracy of ultrasound vs computed tomography scan for upper urinary tract malignancies and development of a risk-based diagnostic algorithm for haematuria in a UK tertiary centre', International urology and nephrology.

Optimizing Upper-Tract Imaging for Non-Visible Haematuria

“…Given the emerging evidence surrounding the low risk of upper-tract malignancies in patients with NVH and the risks to patients associated with CTU, there have been growing trends in the literature to limit the routine use of CTU for investigating patients with NVH, without careful consideration of the risks and benefits [16, 18, 19]. After previously recommending investigation with CTU for patients aged 35 and over, the AUA's guideline on the investigation of microhaematuria introduced in 2020 presents an algorithm for risk-stratifying NVH patients based on age, sex, haematuria presentation, and other risk factors for urothelial malignancy, with ultrasonography replacing CTU for upper-tract imaging in all but high-risk patients [20].…”

“…While smoking was a significant predictor in our univariate analysis, its non-significance in subsequent multivariate analysis may be explained by the lack of accurate quantification of smoking history available to us for analysis retrospectively. While similar investigation pathways have been proposed in the UK, none have yet to become incorporated into a guideline [16].…”

“…There is little debate that CTU is the optimal upper-tract imaging modality for patients at high risk of UTUC, with a sensitivity and specificity of up to 96% and 99%, respectively [13]. While ultrasonography is considered to have reduced diagnostic accuracy and is more operator-dependent, with studies demonstrating a sensitivity ranging from 77% to 100% for diagnosing UTUC in patients with NVH, a recent study in patients undergoing both ultrasonography and CTU reported a 95.8% diagnostic accuracy for ultrasonography compared to 99.1% for CTU [14][15][16]. Despite the clear advantages of CTU for assessing the upper tracts, contrast CT imaging is associated with a significant risk of contrastrelated hypersensitivity reactions and secondary malignancies which should caution its routine use in younger patients presenting with NVH in whom the risk of secondary malignancy may be higher than that of underlying UTUC [14,17].…”

“…Given the emerging evidence surrounding the low risk of upper-tract malignancies in patients with NVH and the risks to patients associated with CTU, there have been growing trends in the literature to limit the routine use of CTU for investigating patients with NVH, without careful consideration of the risks and benefits [16,18,19].…”

Current Concepts in Imaging Asymptomatic Hematuria

“…A recent retrospective study of 575 patients by David et al of a mixed but mainly gross hematuria group of high-risk patients whose ultrasounds were followed by CTU showed the diagnostic accuracy of ultrasound and CTU to be 95.8 and 99.1% respectively (8 renal cell carcinomas and 4 upper tract urothelial carcinomas) with both modalities demonstrating 100% sensitivity. 49 This study was strong in comparing both modalities but limited in the rather small number of actual carcinomas. Another recent study this one by Tan et al followed separate groups using either ultrasound or CTU but not both and found that CTU detected three times as many upper urinary tract malignancies (renal cell carcinoma and urothelial carcinoma) than ultrasound: 53/1692 (3.1%) vs 21/2166 (1.0%).…”