Accuracy of ultrasound vs computed tomography scan for upper urinary tract malignancies and development of a risk-based
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UROLOGY - ORIGINAL PAPER
Accuracy of ultrasound vs computed tomography scan for upper urinary tract malignancies and development of a risk‑based diagnostic algorithm for haematuria in a UK tertiary centre Rotimi A. David1,2 · B. James2 · D. Adeloye3 · P. Bose2 · B. Rai4 · G. V. KandaSwamy2 Received: 15 June 2020 / Accepted: 13 August 2020 © Springer Nature B.V. 2020
Abstract Purpose There is no consensus across guidelines on a diagnostic algorithm for upper urinary tract (UUT) evaluation following presentation with haematuria. Our aim is to compare the diagnostic accuracy of ultrasound (USS) compared to CT-scan for UUT malignancies and also determine the considerations important for a risk-based diagnostic protocol for haematuria. Methods We reviewed our ‘haematuria clinic’ database to identify patients who had both USS and CT-scan for UUT evaluation between September 2015 and August 2017, and calculated the diagnostic accuracy of these imaging modalities for histologically confirmed UUT cancers. Furthermore, we identified risk factors in our diagnostic algorithm for haematuria and conducted regression analysis to determine their ability to predict UUT malignancies. Results Overall, 575 patient records were studied. Age range was 21–92 years, M:F was 1.4:1, majority (81.2%) had visible haematuria, and 12 (2.1%) UUT cancers were diagnosed [renal cell carcinoma—1.4%; upper tract urothelial cancer—0.7%]. USS and CT-scan had diagnostic accuracy for UUT cancers of 95.8 and 99.1%, respectively (p 35 years regardless of haematuria type No specific guidance No specific guidance Asymptomatic microscopic haematuria: physician preference Symptomatic microscopic haematuria and Gross haematuria: CTU Low risk (NVH 50 years and VH 50 years or risk score > 6): CTU Use renal and bladder USS and/or computed tomography–intravenous urography (CT–IVU) during the initial work-up in patients with haematuria NVH–USS Macroscopic haematuria with low and medium probability for urothelial cancer: USS Macroscopic haematuria, at high-risk for urothelial cancer: CTU Low and medium risk: USS High risk: CTU No specific guidance
Dutch guidelines [7] EAU [29] ESUR [30] Japanese guidelines [6] NICE guidelines [19]
UUT upper urinary tract, AUA American Urologic Association, CTU computed tomography urogram, ACP American College of Physicians, BAUS British Association of Urologic Surgeons, USS ultrasound, NVH non-visible haematuria, VH visible haematuria, EAU European Association of Urology, ESUR European Society of Urogenital Radiology, NICE National Institute for Health and Care Excellence
to individualize management when necessary based on patient’s history and context of available resources [4]. Guidelines across Europe, Asia, and other parts of the world, on the other hand, are either silent or recommend a stratified approach with renal ultrasound (USS) as an initial investigative modality for the UUT [2, 5–7]. USS, therefore, remains popular among General practitioners (GPs), Nephrologists, and Urologists in most parts of the g
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