Department of General Surgery, Derriford Hospital, Plymouth, UK.
BJU Int. 2011 Jan;107(2):247-52. doi: 10.1111/j.1464-410X.2010.09521.x. Epub 2010 Aug 19.
• To estimate the diagnostic accuracy of a guidelines-based haematuria clinic protocol by measuring the incidence of undetected malignancy during a follow-up period. • To estimate an individual's post-test risk of having undetected malignancy using the protocol likelihood ratio and the population prevalence of disease.
• Data were collected prospectively on a cohort of 4020 consecutive patients who were referred to a 'one-stop' haematuria clinic between 1998 and 2003. • All patients had a plain radiograph taken and underwent ultrasonography and flexible cystoscopy as a part of 'first-line' investigation. • Intravenous urography was performed where indicated after abnormal first-line tests or in patients with persistent haematuria where no abnormality had been detected. • Records of the initial 687 participants from the first year of the study were reviewed 4 years after the original consultation. Missed diagnoses of urinary tract malignancy were recorded and sensitivities, likelihood ratios and the post-test probability of missing all disease and upper tract malignancy were calculated.
• As previously reported, the overall prevalence of malignant disease was 12.1% (18.9% for macroscopic haematuria compared with 4.8% for microscopic haematuria). • The records of the first year's cohort of patients (N = 687) were analysed 4 years after their original consultation and 10 potentially 'missed' tumours were identified. • The sensitivity of the protocol was 90.9% for the detection of all urinary tract malignancy (95% CI, 82.4 to 95.5) and 71% for upper tract tumours alone (95% CI, 45.4-88.3). The latter improves to 78.6% (95% CI, 52.4-92.4) with the addition of further upper tract testing. • The probability of missing malignant disease overall was 1.7% (95% CI, 0.95-3.04) but this rose sharply to >4% for males over 60 with macroscopic haematuria. • For those with non-visible haematuria, the percentage probability of missed malignant disease was less than 1%.
• The haematuria clinic protocol described is robust but it is not infallible. • The risk of missing malignant disease in the higher risk groups identified in the study is much greater than previous studies would suggest. • If additional upper tract testing or interval follow-up were to be recommended, it could be rationally targeted at these groups, given the measurable risk shown here.
通过测量随访期间未检出恶性肿瘤的发生率，来评估基于指南的血尿诊所方案的诊断准确性。
使用方案似然比和疾病人群患病率来估计个体在检测后患有未检出恶性肿瘤的风险。
1998 年至 2003 年间，前瞻性地收集了 4020 例连续就诊于“一站式”血尿诊所的患者数据。
所有患者均接受了平片检查，并进行了超声检查和软性膀胱镜检查，作为“一线”检查的一部分。
在一线检查异常或持续性血尿且未发现异常的患者中，根据需要进行静脉尿路造影。
对研究第一年的最初 687 名参与者的记录进行了回顾，在最初就诊 4 年后进行。记录了尿路恶性肿瘤的漏诊情况，并计算了漏诊所有疾病和上尿路恶性肿瘤的灵敏度、似然比和检测后患病概率。
正如之前报道的，恶性疾病的总体患病率为 12.1%（肉眼血尿为 18.9%，镜下血尿为 4.8%）。
对第一年患者队列（N=687）的记录进行了分析，在他们最初就诊 4 年后，发现了 10 例潜在的“漏诊”肿瘤。
该方案对所有尿路恶性肿瘤的检测灵敏度为 90.9%（95%CI，82.4 至 95.5），对上尿路肿瘤的检测灵敏度为 71%（95%CI，45.4 至 88.3）。如果加上进一步的上尿路检查，这一比例会提高到 78.6%（95%CI，52.4 至 92.4）。
总体上漏诊恶性肿瘤的概率为 1.7%（95%CI，0.95%至 3.04%），但对于 60 岁以上有肉眼血尿的男性，这一概率急剧上升至>4%。
对于非肉眼血尿患者，漏诊恶性肿瘤的百分比概率小于 1%。
所描述的血尿诊所方案是可靠的，但并非万无一失。
在研究中确定的高风险组中，漏诊恶性肿瘤的风险远高于之前的研究结果。
如果建议进行额外的上尿路检查或间隔随访，可以根据这里显示的可衡量的风险，合理地针对这些人群进行检查。
