Non-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis

Jubber, Ibrahim; Shariat, Shahrokh F.; Conroy, Samantha A.; Tan, Wei Shen; Gordon, Patrick; Lotan, Yair; Messing, Edward M.; Stenzl, Arnulf; Rhijn, Bas van; Kelly, John D.; Catto, James W.F.; Cumberbatch, Marcus

doi:10.1016/j.eururo.2019.10.010

Cited by 43 publications

(47 citation statements)

References 83 publications

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“…In patients with NVH the risk for UTM was low and it remains questionable if any further investigations should be recommended at all. Our data reveals that the in patients with NVH the incidence of BCA is 1-3%, of RCC 1-2% and of UTUC in 0-1% which is in line with previous reports (Davis et al 2012;Edwards et al 2006;Jubber et al ;Samson et al 2017;Tan et al 2018). For the lower urinary tract, cystoscopy represents the diagnostic gold standard but represents an invasive investigation which is associated with a risk of urinary tract infections (Johnson et al 2007), gross hematuria and patient discomfort.…”

Section: Discussionsupporting

confidence: 91%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 91%

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

et al. 2020

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“…BC is one of the commonest human cancers and one of the most expensive to manage. Much of this expense is spent on monitoring patients with NMI cancers or in screening people with non-visible haematuria [2,25]. Better targeting of resource, with improved survival, more effective screening and lower costs, could be achieved if patient risk stratification was available [26].…”

Section: Plos Onementioning

confidence: 99%

“…Bladder cancer (BC) is a common human malignancy and one of the most expensive to manage [1]. Most tumours present with haematuria [2] and at diagnosis around 30% are muscle invasive and 70% non-muscle invasive cancers (NMI) [3]. NMI tumours are stratified into low and high grade lesions, to reflect different treatments and outcomes [4].…”

Section: Introductionmentioning

confidence: 99%

Occupational bladder cancer: A cross section survey of previous employments, tasks and exposures matched to cancer phenotypes

et al. 2020

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Objectives Up to 10% of Bladder Cancers may arise following occupational exposure to carcinogens. We hypothesised that different cancer phenotypes reflected different patterns of occupational exposure. Methods Consecutive participants, with bladder cancer, self-completed a structured questionnaire detailing employment, tasks, exposures, smoking, lifestyle and family history. Our primary outcome was association between cancer phenotype and occupational details. Results We collected questionnaires from 536 patients, of whom 454 (85%) participants (352 men and 102 women) were included. Women were less likely to be smokers (68% vs. 81% Chi sq. p<0.001), but more likely than men to inhale environmental tobacco smoke at home (82% vs. 74% p = 0.08) and use hair dye (56% vs. 3%, p<0.001). Contact with potential carcinogens occurred in 282 (62%) participants (mean 3.1 per worker (range 0-14)). High-grade cancer was more common than low-grade disease in workers from the steel, foundry, metal, engineering and transport industries (p<0.05), and in workers exposed to crack detection dyes, chromium, coal/oil/gas by-products, diesel fumes/fuel/aircraft fuel and solvents (such as trichloroethylene). Higher staged cancers were frequent in workers exposed to Chromium, coal products and diesel exhaust fumes/fuel (p<0.05). Various workers (e.g. exposed to diesel fuels or fumes (Cox, HR 1.97 (95% CI 1.31-2.98) p = 0.001), employed in a garage (HR 2.19 (95% CI 1.31-3.63) p = 0.001), undertaking plumbing/gas fitting/ventilation (HR 2.15 (95% CI 1.15-4.01) p = 0.017), undertaking welding (HR 1.85 (95% CI 1.24-2.77) p = 0.003) and exposed to welding materials (HR 1.92 (95% CI 1.27-2.91) p = 0.002)) were more likely to

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“…NVH referrals to secondary care are based on dipstick testing which is the preferred method for assessment in general practice [4]. The main concern is to exclude urological cancer and a recent metanalysis reported that NVH evaluation detected, bladder cancer (BC), kidney cancer (KC) and upper tract urothelial cancer (UTUC) in 3.2%, 0.28% and 0.04% of cases, respectively [6]. In general, diagnostic yield of significant benign cause is in the range of 28-38% and up to 100% including all less significant causes, depending on the method of investigations and population [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Does non-visible haematuria require urgent assessment? A retrospective cohort study from a university teaching hospital

et al. 2021

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Objectives It is not certain from current evidence which patient groups with non-visible haematuria (NVH) require urgent investigation and which investigations are sufficient. We report referral outcomes data from Scotland to identify patient groups who will benefit from urgent assessment to rule out urological cancer (UC) and whether full set of investigations are necessary in all referred patients. Materials and methods Data were collected from electronic patient records for patients referred with NVH to secondary care urology services between July 2017 and May 2020. The correlations between risk factors and final diagnosis were assessed using categorical variables in a multivariate logistic regression analysis and using chi-squared models. Statistical analysis was performed using IBM SPSS data editor version 25. Results Our study cohort comprised 525 patients (43.4% males; median age 66 years), in which UC was diagnosed in 25 patients (4.8%). Age > 60 years had sensitivity and NPV for UC of 92% and 99%, respectively. Univariate and multivariate analysis showed male sex, age ≥ 60 years and smoking were significant predictors of UC in patients with NVH (p < 0.05). There was no significant difference in UC in patients with history of LUTS, anticoagulation and previous UC. Conclusion The risk of urologic cancer in NVH patients is significant and male gender, age ≥ 60 years and smoking are significant predictors of UC. Patients with risk factors of UC require complete assessment of both the upper and lower urinary tract; however, in the absence of risk factors, patients do not require urgent or complete assessment.

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Non-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis

Cited by 43 publications

References 83 publications

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

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

Occupational bladder cancer: A cross section survey of previous employments, tasks and exposures matched to cancer phenotypes

Does non-visible haematuria require urgent assessment? A retrospective cohort study from a university teaching hospital

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