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Diagnostic yield of upper tract imaging performed for hematuria screening: Results from a national, privately-insured cohort

Objectives: To increase the population-level understanding of upper tract imaging evaluation during risk-based hematuria assessment. Using a national, privately-insured cohort, we evaluated the rates of imaging and the diagnostic yield of each imaging modality. We hypothesized that the rate of upper tract disease would be low and that the benefit of computed tomography over renal ultrasound would be limited.

Methods: We identified patients with an incident diagnosis of microscopic or gross hematuria between 2010 and 2015 within the MarketScan database. Multivariable logistic regression was used to predict the adjusted likelihood of any upper tract finding, with a subset analysis limited to malignant outcomes.

Results: We identified 466,710 patients; 150,880 (32.3%) received ultrasound, 219,449 (47.0%) received computed tomography, and 96,381 (20.7%) received other imaging. Ultrasound detected 1,469 findings among 150,880 patients (1%); computed tomography detected 3,764 findings among 219,449 patients (1.7%); other imaging detected 2,612 findings among 96,381 patients (2.7%) (P < 0.0001). When adjusted for comorbidities, increased age, male sex, increased Elixhauser index, gross hematuria, and CT or other imaging were associated with upper tract findings, in the overall and subset analysis (all p < 0.0001).

Conclusions: The diagnostic yield of imaging is higher than expected; however, the detection rate remained low. As supported by updated clinical practice guidelines, clinicians should pursue risk-based imaging strategies during hematuria evaluation, although these data may support increased utilization of ultrasound at the initial evaluation.

Eric Ballon-Landa M.D., M.P.H.1,2 Alex Hannemann M.D.1,2 Boris Gershman M.D.3 Rodrigo Rodrigues Pessoa M.D., Ph.D.4 Brian Olson B.S.5 Peter E. Clark M.D.6 Michael Bronsert Ph.D.2 Jeffrey C. Morrison M.D.7 Granville L. Lloyd M.D.1,2 Badrinath Konety M.D.8 Simon P. Kim M.D., M.P.H.2

  1. Rocky Mountain Regional VA Medical Center, Aurora, CO
  2. CU Anschutz School of Medicine, Aurora, CO
  3. Beth Israel Deaconness Medical Center, Boston, MA
  4. Mayo Clinic, Rochester, MN
  5. University of Kentucky College of Medicine, Lexington, KY
  6. Atrium Health, Charlotte, NC
  7. UCLA Health, Los Angeles, CA
  8. Rush College of Medicine, Chicago, IL
Source: 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: Seminars and Original Investigations, Volume 42, Issue 1, 2024, Pages 21.e1-21.e7, ISSN 1078-1439.

Read an Expert Commentary by Bishoy Faltas, MD