Commander Clayton W, Johnson David C, Raynor Mathew C, Burke Lauren M, Hacker Kathryn E, Hoag Bryan, Fielding Julia R, Semelka Richard C, Lee Ellie R
Department of Radiology, University of North Carolina, Chapel Hill, NC.
Department of Urology, University of North Carolina, Chapel Hill, NC.
Urology. 2017 Apr;102:31-37. doi: 10.1016/j.urology.2016.10.055. Epub 2017 Jan 11.
To evaluate the age-stratified prevalence of upper tract urothelial malignancies diagnosed on computed tomography urography in a large cohort of patients referred for initial evaluation of hematuria.
A total of 1123 consecutive adults without a history of urothelial cancer underwent initial computed tomography urography for gross hematuria (n = 652), microscopic hematuria (n = 457), or unspecified hematuria (n = 14) at a single institution from October 2006 to October 2012. Imaging findings suggestive of urothelial lesions were correlated with clinical information, including cystoscopy, cytology, and surgical pathology reports. Patients subsequently diagnosed with urothelial cancer following a normal radiographic evaluation were identified and analyzed. Age, gender, smoking history, and location and type of malignancy were analyzed.
Upper tract urothelial cancer was detected in 4 (0.36%) patients, with a mean age of 66.5 years. All 4 patients presented with gross hematuria and were current or former smokers. None of the 535 patients under age 55 who underwent computed tomography urography were diagnosed with upper tract disease regardless of age, smoking history, or degree of hematuria. Likewise, no upper tract cancers were detected in patients referred for microscopic hematuria, regardless of age.
Detection of upper tract urothelial cancer by computed tomography urography is exceedingly rare in patients presenting at a tertiary referral center with hematuria, particularly in the lower risk strata (younger age, microscopic hematuria). Further investigation into risk-stratified approaches to imaging for hematuria workup is warranted to minimize unnecessary costs and radiation exposure.
在一大群因血尿初次就诊而接受评估的患者中，评估通过计算机断层扫描尿路造影诊断出的上尿路尿路上皮恶性肿瘤的年龄分层患病率。
2006年10月至2012年10月期间，在一家机构中，共有1123名无尿路上皮癌病史的连续成年患者因肉眼血尿（n = 652）、镜下血尿（n = 457）或未明确的血尿（n = 14）接受了初次计算机断层扫描尿路造影。提示尿路上皮病变的影像学表现与临床信息相关，包括膀胱镜检查、细胞学检查和手术病理报告。确定并分析随后在影像学评估正常后被诊断为尿路上皮癌的患者。分析了年龄、性别、吸烟史以及恶性肿瘤的位置和类型。
4例（0.36%）患者检测出上尿路尿路上皮癌，平均年龄为66.5岁。所有4例患者均表现为肉眼血尿，且均为现吸烟者或既往吸烟者。在接受计算机断层扫描尿路造影的535例55岁以下患者中，无论年龄、吸烟史或血尿程度如何，均未诊断出上尿路疾病。同样，在因镜下血尿就诊的患者中，无论年龄如何，均未检测出上尿路癌症。
在三级转诊中心因血尿就诊的患者中，通过计算机断层扫描尿路造影检测上尿路尿路上皮癌极为罕见，尤其是在低风险人群（年龄较小、镜下血尿）中。有必要进一步研究针对血尿检查的风险分层成像方法，以尽量减少不必要的费用和辐射暴露。
