Departments of Medical Education, Gundersen Health System, La Crosse, WI.
Departments of Medical Research, Gundersen Health System, La Crosse, WI.
Urology. 2019 Nov;133:34-39. doi: 10.1016/j.urology.2019.07.009. Epub 2019 Jul 13.
To evaluate the sensitivity of ultrasound imaging in detecting upper urinary tract malignancy in patients with asymptomatic microscopic hematuria (AMH) in an outpatient community setting.
A list of all patients who received renal ultrasound for hematuria in our health care system between January 1, 1997 and July 1, 2015 was obtained, and electronic health records were retrospectively reviewed. Patients were excluded for age (<18 years), <3 years follow-up, prior upper tract malignancy, recent urinary tract catheterization, inpatient status, pregnancy, insufficient data, or gross hematuria. The initial ultrasound was considered positive if suspicious findings led to a subsequent diagnosis of an upper tract malignancy. False negatives were determined by electronic medical record follow-up for at least 3 years.
Of the 2138 patients with AMH who met inclusion criteria, ultrasound imaging detected suspicious findings in 9 of 9 patients with renal cell carcinoma and 3 of 3 patients with upper tract urothelial cancer, indicating a sensitivity of 100% and 100%, respectively. Four additional malignancies were diagnosed more than 3 years after the initial evaluation for an incidence rate of 1.6 cases of upper tract malignancy per 10,000 person-years.
The prevalence of upper urinary tract malignancy was low in patients with AMH. Ultrasonography is an appropriate modality for upper tract imaging in the initial evaluation of patients with AMH. Practice guidelines should be updated to reflect the high sensitivity of ultrasound and low risk of upper tract malignancy in patients with AMH.
评估在社区门诊环境中，对于无症状性镜下血尿（AMH）患者，超声成像在上尿路恶性肿瘤检测中的灵敏度。
获取 1997 年 1 月 1 日至 2015 年 7 月 1 日期间在我们医疗系统中因血尿接受肾脏超声检查的所有患者名单，并回顾性审查电子病历。排除标准为年龄（＜18 岁）、随访时间＜3 年、上尿路恶性肿瘤病史、近期尿路置管、住院状态、妊娠、资料不完整或肉眼血尿。如果可疑发现导致随后诊断为上尿路恶性肿瘤，则将初始超声视为阳性。通过电子病历随访至少 3 年确定假阴性。
在符合纳入标准的 2138 例 AMH 患者中，超声成像在 9 例肾细胞癌和 3 例上尿路尿路上皮癌患者中均发现可疑表现，灵敏度分别为 100%和 100%。另外 4 例恶性肿瘤在初始评估后 3 年以上被诊断，发病率为每 10000 人年 1.6 例上尿路恶性肿瘤。
AMH 患者上尿路恶性肿瘤的患病率较低。超声检查是 AMH 患者初始评估时上尿路成像的适当方法。应更新实践指南，以反映超声检查的高灵敏度和 AMH 患者上尿路恶性肿瘤的低风险。
