Diagnostic accuracy of ultrasonography, computed tomography, cystoscopy and cytology to detect urinary tract malignancies in patients with asymptomatic hematuria

Abstract

PURPOSE: To report the incidence of urinary tract malignancies (UTM) and to compare the diagnostic accuracy of cytology with cystoscopy, renal ultrasound (US) and computed tomography (CT) in patients with hematuria. METHODS: A retrospective analysis was conducted of patients who underwent cystoscopy, cytology, US and CT for hematuria between 2011 and 2017. Age, gender, BMI, smoking status, and results of further diagnostic interventions including transurethral resection of the bladder (TURB), ureterorenoscopy (URS), renal biopsy and imaging were extracted from medical charts. Logistic regression to identify risk factors for UTM was performed. Discriminatory accuracy of US, CT and cytology was assessed by 2 × 2 tables. RESULTS: Of 847 patients, 432 (51%) presented with nonvisible hematuria (NVH) and 415 (49%) with visible hematuria (VH). Of all patients with NVH, seven (1.6%) had bladder cancer (BCA), three (< 1%) had renal cell cancer (RCC) and no single patient had upper tract urothelial cancer (UTUC). Of the patients with VH, 62 (14.9%) were diagnosed with BCA, 7 (1.6%) with RCC and 4 (< 1%) with UTUC. In multivariable analysis VH, higher age, smoking and lower BMI were associated with an increased risk for UTM. The specificity/negative predictive value of US for the detection of RCC or UTUC in patients with NVH and VH were 96%/100% and 95%/99%, respectively. CONCLUSION: Due to the low incidence of UTM, the necessity of further diagnostics should be questioned in patients with NVH. In contrast, patients with VH are at considerable risk for BCA, and cystoscopy and upper tract imaging is justified.

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

“…There are many possible benign urologic or systemic aetiologies for haematuria, and it is also possible that visible haematuria is a progression of non-visible haematuria in patients with UUT cancers. It is however important to highlight that no UUT mitotic lesion was diagnosed following presentation with non-visible haematuria in this study; supporting previous publications demonstrating that UUT malignancies are a rare occurrence in non-visible haematuria [3], [23].…”

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

“…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.…”

Assessment of Diagnostic Yield of Cystoscopy and Computed Tomographic Urography for Urinary Tract Cancers in Patients Evaluated for Microhematuria

“… 8 , 52 Further harm is associated with false-positive findings, which may produce consequences through either invasive diagnostic assessments, repeated imaging, or even partial or radical nephrectomy. 9 , 24 , 27 , 30 Halpern et al 7 reported that the additional diagnostic benefit of CT urography vs ultrasonography for evaluating MH would cost $6 480 484 per additional tumor detected. Therefore, the AUA updated its 2012 recommendation, 53 in which it endorsed upper urinary tract imaging using CT urography for all patients, to recommend restricting CT urography to high-risk patients (ie, women or men aged ≥60 years, >30 pack-years, >25 RBCs per HPF on a single urinalysis, or history of gross hematuria) in its 2020 guidelines.…”

“… 2 , 4 Ultrasonography has acceptable sensitivity for detection of KCC and a high negative predictive value for UTUC among patients with MH. 6 , 9 Furthermore, ultrasonography is cost-efficient and does not expose patients to harmful radiation. 7 , 8 A recent systematic review and meta-analyses by Jubber et al, 56 which found similar detection rates, also recommended using ultrasonography as first-line imaging.…”

“…Nevertheless, some studies have questioned the use of CT urography as first-line imaging given the low prevalence of UTUC and concerns about radiation exposure (especially among young patients with MH) as well as the possible consequences of false-positive findings. 6 , 7 , 8 , 9 The diagnostic yields of cystoscopy for detecting bladder cancer and CT urography for detecting upper UTCs among patients with MH remain uncertain. Thus, despite the plethora of published data, the ideal workup for patients with MH remains unknown.…”