MP63-15 CAN RENAL TRACT ULTRASOUND REPLACE CT UROGRAPHY FOR THE EVALUATION OF MICROSCOPIC HEMATURIA? RESULTS OF A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology IV1 Apr 2018MP63-15 CAN RENAL TRACT ULTRASOUND REPLACE CT UROGRAPHY FOR THE EVALUATION OF MICROSCOPIC HEMATURIA? RESULTS OF A PROSPECTIVE OBSERVATIONAL STUDY Wei Shen Tan, Andrew Feber, Liqin Dong, Rachael Sarpong, Simon Rodney, Pramit Khetrapal, Patricia de Winter, Rumana Jalil, Norman Williams, Chris Brew-Graves, John Kelly, and DETECT I trial group Wei Shen TanWei Shen Tan More articles by this author , Andrew FeberAndrew Feber More articles by this author , Liqin DongLiqin Dong More articles by this author , Rachael SarpongRachael Sarpong More articles by this author , Simon RodneySimon Rodney More articles by this author , Pramit KhetrapalPramit Khetrapal More articles by this author , Patricia de WinterPatricia de Winter More articles by this author , Rumana JalilRumana Jalil More articles by this author , Norman WilliamsNorman Williams More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , John KellyJohn Kelly More articles by this author , and DETECT I trial groupDETECT I trial group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2038AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American Urology Association recommends that CT urography should be the upper tract imaging of choice for the evaluation of both gross and microscopic hematuria patients. In a prospective observational study (clinicaltrials.gov NCT02676180), we determine and compare the diagnostic accuracy of both CT urography and renal tract ultrasound (RTU) at identifying urinary tract cancer (UTC). METHODS The DETECT I study prospectively recruited patients investigated for hematuria at 40 hospitals. All patients had cystoscopy and CT urography and/ or RTU as part of haematuria evaluation. Bladder cancer was defined as histologically confirmed cancer following transurethral resection of bladder cancer or bladder biopsy. Upper tract tumours (renal parenchymal cancers or upper tract transitional cell carcinoma (TCC)) were determined following review of scans at tumour board meeting. RESULTS 3561 patients with a median age of 68 years (IQR: 57, 76) were recruited between March 2016 to June 2017. The overall incidence of UTC was 10% (bladder cancer: 8.0%, renal parenchymal cancer 1.1%, upper tract TCC: 0.7%). Of the 448 patients (13%) who had both RTU and CT urography, 64 bladder cancers, 9 renal parenchymal cancer and 6 upper tract TCC were diagnosed. RTU had a sensitivity of 89% (n=8) of identifying renal parenchymal cancers with a positive predictive value (PPV) of 53%. The negative predictive value (NPV) of RTU of ruling out renal parenchymal tumours was >99.5%. Of the 6 upper tract TCC identified on CT urography, RTU missed 3 cases. No upper tract TCC was identified following a presentation of microscopic hematuria. 2104 patients (59%) had RTU while 1608 patients (45%) had a CT urography. The diagnostic accuracy for RTU to detect bladder cancer was: sensitivity: 66%, specificity 99%, PPV 82% and NPV 98%. CT urography identified bladder cancer with a sensitivity of 87%, specificity of 97%, PPV of 79% and NPV of 99%. CONCLUSIONS CT urography can safely replace URT when evaluating patients presenting with microscopic hematuria due to the low risk of upper tract TCC. In patients with gross hematuria, the incidence of upper tract TCC is 1% and CT urography is indicated because of its superiority at identifying upper tract TCC compared to RTU. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e846-e847 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Wei Shen Tan More articles by this author Andrew Feber More articles by this author Liqin Dong More articles by this author Rachael Sarpong More articles by this author Simon Rodney More articles by this author Pramit Khetrapal More articles by this author Patricia de Winter More articles by this author Rumana Jalil More articles by this author Norman Williams More articles by this author Chris Brew-Graves More articles by this author John Kelly More articles by this author DETECT I trial group More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...