Upper tract imaging modality to investigate haematuria: cancer detection rates and changing guidelines

Lee Chien Yap,Anna L Walsh,Ken Patterson,Daniel Peter Mcnicholas,Richard Power,Abdul Rauf

doi:10.1186/s12301-021-00179-1

Lee Chien Yap, Anna L Walsh + Show 4 more

Open Access

https://doi.org/10.1186/s12301-021-00179-1

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Abstract

BackgroundTo assess the imaging modalities used to investigate both visible haematuria and non-visible haematuria along with their detection rate of malignancy at two hospitals and the corresponding radiological workload produced.MethodsA retrospective study was conducted across two hospitals. All CT urograms and ultrasound scans investigating haematuria in the outpatient setting over a 12-month period were evaluated.ResultsThe detection rate for upper tract urothelial cancer with visible haematuria was 0.97% and for renal cell carcinoma was 0.64%. Of all the CT urograms performed for non-visible haematuria 4.9% had suspicious findings but none of these represents an underlying malignancy. Of all the ultrasound scans performed for either visible or non-visible haematuria, none were shown to have an underlying malignancy. The detection rate was thus zero for an upper tract urinary cancer or renal cell carcinoma in the non-visible haematuria group. A CT urogram was performed in 27% and 67% of cases in each respective hospital to further investigate non-visible haematuria. CT urography makes up 2.3% and 5.2% of each hospitals overall respective workload in the CT department. CT urography to investigate non-visible haematuria could be replaced by ultrasound in low-risk patients.ConclusionsRadiological investigations are a limited resource and better rationalisation of upper tract imaging is needed in the setting of haematuria. Risk stratification of patients would be of benefit to help prevent a significant delay in timely diagnostics for higher risk individuals presenting with haematuria.

Highlights

To assess the imaging modalities used to investigate both visible haematuria and non-visible haematuria along with their detection rate of malignancy at two hospitals and the corresponding radiological workload produced
The second edition of the Oxford Handbook of Urology published in 2009 quotes a bladder cancer incidence rate of 34% for patients > 50 years presenting with visible haematuria (VH) [4]
Similar rates of change are quoted in the non-visible haematuria (NVH) group with incidence rates of up to 13% dropping to 1.6% in the > 50 years population and less than 1% in younger patients

Summary

Introduction

To assess the imaging modalities used to investigate both visible haematuria and non-visible haematuria along with their detection rate of malignancy at two hospitals and the corresponding radiological workload produced. The quoted incidence of a urological malignancy with both VH and NVH has changed over the last number of years in main stream text books. The second edition of the Oxford Handbook of Urology published in 2009 quotes a bladder cancer incidence rate of 34% for patients > 50 years presenting with VH [4]. Similar rates of change are quoted in the NVH group with incidence rates of up to 13% dropping to 1.6% in the > 50 years population and less than 1% in younger patients. These discrepancies in the incidence rates for bladder cancer are reflected in the literature [6]. NVH has been shown to be a poor screening tool for bladder malignancy as is positive urine cytology with lead times for positive cytology and a positive NVH test of eight and three months, respectively [7]

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