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Ultrasonography of the Adult Male Urinary Tract for Urinary Functional Testing
Published on: August 14, 2019
Examining the upper urinary tract in patients with hematuria-time to revise the CT urography protocol?
Erik Rud1, Kristina Flor Galtung2, Peter Mæhre Lauritzen2
1Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway. erik.rud@ous-hf.no.
Insights
Three-phase CT urography (CTU) accurately detects upper urothelial cell carcinomas (UCC) in patients with hematuria and negative cystoscopy. All identified UCCs were visible on the nephrographic phase, suggesting potential protocol simplification.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Three-phase CT urography (CTU) is the standard for evaluating the upper urinary tract in patients with hematuria.
- Negative cystoscopy results do not exclude upper tract urothelial cell carcinoma (UCC).
Purpose of the Study:
- To evaluate the accuracy of CTU in detecting upper UCCs in patients presenting with hematuria and a negative cystoscopy.
- To determine the visibility of UCCs across different phases of CTU.
Main Methods:
- Retrospective study of 376 patients with hematuria undergoing CTU after negative cystoscopy (2016-2017).
- Reference standard included biopsies and clinical follow-up with a minimum 18-month follow-up.
- Two reviewers assessed tumor visibility on each CTU phase for true-positive cases.
Main Results:
- CTU demonstrated high accuracy (99%) for detecting upper UCCs, with 100% sensitivity and 100% negative predictive value.
- The incidence of upper UCC was 1.9% (7 cases).
- All detected UCCs were visible on the nephrographic phase by both reviewers.
Conclusions:
- CT urography is a highly accurate imaging modality for diagnosing upper tract urothelial cell carcinomas in patients with hematuria and negative cystoscopy.
- The nephrographic phase is crucial for visualizing all detected UCCs, potentially allowing for CTU protocol optimization.
- All identified cancers occurred in patients with macroscopic hematuria.
Background:
Three-phase CT urography (CTU) is the gold standard for evaluating the upper urinary tract in patients with hematuria. We aimed to evaluate the accuracy of CTU for detecting upper urothelial cell carcinomas (UCC) in patients with hematuria and negative cystoscopy. Secondly, we aimed to determine the tumor visibility on each CTU phase.
Material And Methods:
This retrospective study included all patients with hematuria referred to CTU after a negative cystoscopy during 2016 and 2017. The original CTU reports were dichotomized as negative or positive. All patient charts were reviewed after a minimum of 18-month follow-up in order to register missed cancers. The results of biopsies and clinical follow-up were used as the reference standard. Two reviewers retrospectively evaluated the tumor visibility of each CT sequence in all true-positive CTUs.
Results:
We included 376 patients with hematuria who underwent CTU after a negative cystoscopy. Macroscopic and microscopic hematuria occurred in 87% (327) and 13% (49), respectively. The incidence of upper urothelial cell carcinoma was 1.9% (7), and the sensitivity of CTU was 100% (95% CI, 59-100), specificity was 99% (95% CI, 98-100), positive predictive value was 88% (95% CI, 47-99), and negative predictive value was 100% (95% CI, 99-100). The accuracy was 99% (95% CI, 90-100). All UCCs were visible on the nephrographic phase for both reviewers.
Conclusion:
CTU is highly accurate for detecting upper UCCs. All cases were seen on the nephrographic phase. This suggests that the CTU protocol can be simplified.
Key Points:
• CT urography is highly accurate for detecting upper urothelial cell carcinomas. • All cancers were seen on the nephrographic phase. • All cancers were detected in patients with macroscopic hematuria.
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