Ballon-Landa et al. used a private health insurance database to collect data for patients with an incident diagnosis of microscopic or gross hematuria. The cohort consisted of 466,710 patients, of whom 35% had gross hematuria. Men were significantly less likely to receive renal ultrasound than computed tomography (CT) or other imaging (p < 0.0001). A similar pattern was observed for patients with gross hematuria (p < 0.0001). Overall, the annual rate of renal ultrasound decreased from 21.1% in 2010 to 15.8% in 2014 (p < 0.0001).
There was a significant difference in diagnostic yield across imaging modalities, whereby ultrasound was associated with the lowest yield of UT findings (1.0%) compared to CT (1.7%) or other imaging modalities (2.7%; p < 0.0001). The total proportion of patients with any UT finding was 1.7%. Significantly higher proportions of renal lesions were detected using renal ultrasound (55.1%) and CT (69.7%) compared to other imaging (43.9%; p < 0.0001). CT led to higher detection of ureteral lesions than ultrasound or other imaging (11.5%, 7.1%, and 7.9%, respectively; p < 0.0001). A higher proportion of stone disease was identified using other imaging (49.6%) than ultrasound (39.0%) or CT (20.4%; p < 0.0001). In an adjusted multivariate analysis, the following variables were significantly associated with an increased probability of any UT finding (p < 0.0001): increased age, male sex, increased comorbidities, and gross hematuria. Another analysis identified the following factors that were significantly associated with detecting a malignant finding: advanced age, male sex, increased comorbidities, gross hematuria, and CT or other imaging.
The investigators conclude that the diagnostic yield for UT imaging as a workup for microhematuria is low. Rather, patients should be selected for imaging evaluation on an individualized basis upon consideration of relevant clinical variables. One of the limitations of this study is a lack of information regarding imaging choice. Furthermore, cost and access factors need to be considered.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
References:
- Ballon-Landa E, Hannemann A, Gershman B, et al. Diagnostic yield of upper tract imaging performed for hematuria screening: results from a national, privately-insured cohort. Urologic oncology. 2023.
- Barocas DA, Boorjian SA, Alvarez RD, et al. Microhematuria: AUA/SUFU guideline. J Urol 2020;204(4):778–86.
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