Evaluation of microscopic hematuria and risk of urologic cancer in female patients

Lippmann, Quinn K.; Slezak, Jeff; Menefee, Shawn A.; Ng, Casey K.; Whitcomb, Emily L.; Loo, Ronald K.

doi:10.1016/j.ajog.2016.10.008

Cited by 15 publications

(19 citation statements)

References 17 publications

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“…Of these, 19,959 were excluded by title and abstract screening and 686 after full-text assessment. We identified 20 studies, describing 29 models, which satisfied the inclusion criteria [10,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Internal validation -either bootstrapping [17][18][19][20] or split-sampling (random [22][23][24]34] or nonrandom [28,29]) -has been carried out for 22 models. Only eight models have been externally validated [10,25,27,28].…”

Section: Study Design and Settingmentioning

confidence: 99%

“…Cha2012d also included the results of cytology as a risk factor; this does not seem to improve model performance. The models by Loo [28] include an indication of the severity of NVH (>25 RBC/hpf), Loo2013b has high discrimination (AUROC=0.809) in external validation [27].…”

Section: Performance Measuresmentioning

confidence: 99%

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Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review

Harrison

Usher‐Smith

et al. 2021

Br J Gen Pract

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BackgroundTimely diagnosis of bladder and kidney cancer is key to improving clinical outcomes. Given the challenges of early diagnosis, models incorporating clinical symptoms and signs may be helpful to primary care clinicians when triaging at-risk patients.AimTo identify and compare published models that use clinical signs and symptoms to predict the risk of undiagnosed prevalent bladder or kidney cancer.Design and settingSystematic review.MethodA search identified primary research reporting or validating models predicting the risk of bladder or kidney cancer in MEDLINE and EMBASE. After screening identified studies for inclusion, data were extracted onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool.ResultsThe search identified 20 661 articles. Twenty studies (29 models) were identified through screening. All the models included haematuria (visible, non-visible, or unspecified), and seven included additional signs and symptoms (such as abdominal pain). The models combined clinical features with other factors (including demographic factors and urinary biomarkers) to predict the risk of undiagnosed prevalent cancer. Several models (n = 13) with good discrimination (area under the receiver operating curve >0.8) were identified; however, only eight had been externally validated. All of the studies had either high or unclear risk of bias.ConclusionModels were identified that could be used in primary care to guide referrals, with potential to identify lower-risk patients with visible haematuria and to stratify individuals who present with non-visible haematuria. However, before application in general practice, external validations in appropriate populations are required.

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Section: Resultsmentioning

confidence: 99%

Section: Study Design and Settingmentioning

confidence: 99%

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Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review

Harrison

Usher‐Smith

et al. 2021

Br J Gen Pract

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“…Seven studies recommended age thresholds between 50 and 65 years for initiating an evaluation in response to an MH diagnosis. 11 , 26 , 34 , 35 , 36 , 40 , 42 However, a fixed age threshold is difficult to define because several studies have reported bladder cancer in patients younger than 60 years. 6 , 21 One of those studies reported bladder cancer in 1.2% of patients younger than 40 years.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The authors proposed using a cutoff of greater than 25 red blood cells per high-power field among women older than 40 years, noting this approach had a better sensitivity, specificity, and positive predictive value than the 2012 recommendations (17). In addition, a follow-up study of 3,573 women referred for urologic evaluation for asymptomatic hematuria, performed by Kaiser Permanente Southern California, found that being older than 60 years and having a history of smoking, gross hematuria, or both, were the strongest predictors of urologic cancer (5). Absent these risk factors, the rate of urologic cancer did…”

Section: The Evaluation Of Microscopic Hematuria and The Detection Ofmentioning

confidence: 99%

Committee Opinion No.703: Asymptomatic Microscopic Hematuria in Women

2017

Obstetrics &Amp; Gynecology

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Asymptomatic microscopic hematuria is an important clinical sign of urinary tract malignancy. Asymptomatic microscopic hematuria has been variably defined over the years. In addition, the evidence primarily is based on data from male patients. However, whether the patient is a man or a woman influences the differential diagnosis of asymptomatic microscopic hematuria, and the risk of urinary tract malignancy (bladder, ureter, and kidney) is significantly less in women than in men. Among women, being older than 60 years, having a history of smoking, and having gross hematuria are the strongest predictors of urologic cancer. In low-risk, never-smoking women younger than 50 years without gross hematuria and with fewer than 25 red blood cells per high-power field, the risk of urinary tract malignancy is less than or equal to 0.5%. Furthermore, the evaluation may result in more harm than benefit and is unlikely to be cost effective. Thus, data support changing current hematuria recommendations in this low-risk group. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society encourage organizations producing future guidelines on the evaluation of microscopic hematuria to perform sex-specific analysis of the data and produce practical sex-specific recommendations. In the meantime, the American College of Obstetricians and Gynecologists and the American Urogynecologic Society recommend that asymptomatic, low-risk, never-smoking women aged 35-50 years undergo evaluation only if they have more than 25 red blood cells per high-power field.

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Evaluation of microscopic hematuria and risk of urologic cancer in female patients

Cited by 15 publications

References 17 publications

Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review

Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review

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

Committee Opinion No.703: Asymptomatic Microscopic Hematuria in Women

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