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Cost-effective evaluation of indeterminate urinary cytology
D E Novicki1, J A Stern, R Nemec
1Department of Urology, Mayo Clinic Scottsdale, Arizona, USA.
The Journal of Urology
|August 28, 1998
Summary
Indeterminate urinary cytology requires careful evaluation. Patients without hematuria, a history of urothelial cancer, or smoking habits may not need further urological assessment, improving cost-effectiveness.
Area of Science:
- Urology
- Oncology
Background:
- Indeterminate urinary cytology results present a diagnostic challenge.
- Determining the necessity for comprehensive urological evaluation is crucial for cost-effective patient management.
Purpose of the Study:
- To establish a cost-effective scheme for evaluating indeterminate urinary cytologies.
- To identify key clinical factors that indicate the need for a complete urological evaluation to maximize cancer detection.
Main Methods:
- Retrospective analysis of 389 patients with indeterminate urinary cytology undergoing complete urological evaluations.
- Inclusion of upper urinary tract imaging, cystoscopy, and biopsy results.
- Multivariate analysis to identify significant clinical predictors for malignancy and cost-effectiveness analysis.
Main Results:
- Fifteen percent (60/389) of patients were diagnosed with urinary tract malignancy.
- History of urothelial malignancy and hematuria were significant indicators for complete evaluation.
- Including smoking history would have detected 98.3% of malignancies.
Conclusions:
- Nonsmokers with indeterminate urinary cytology, lacking hematuria and a history of urothelial cancer, are at low risk.
- These low-risk patients may not require extensive urological evaluation, optimizing resource allocation.