MyChart/Editorial/Paper: Detection of Upper Tract Urothelial Malignancies by CT Urography in Patients Referred for Hematuria at a Large Tertiary Referral Center

Blogger's Note: the paper and editorial (per links below) were of obvious interest to me. I have partially copied my clinical records so that others who have an interest in this area, including UTUC urology patients, Lynch Syndrome patients and those with MPM (multiple primary malignancies), may be aware of exceptions/rare incidents in the research.

(partial) Radiology report: 

• The CT urogram was performed including precontrast scans
• Clinical Information: microhematuria/Lynch syndrome/ovarian Ca/XRT/precancerous bowel polyps 
• EPR: Cystoscopy August 17, 2012- cytology negative for malignancy) Comparison: No prior available. 

An elongated noncalcified soft tissue mass measuring 1 x 1.1 x 2.4 cm is seen at the level of the iliac vessels crossing

(partial) Pathology report:

 



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Editorial
 Published online: January 12, 2017
 In the absence of clearly identifiable benign causes (ie, urinary tract infection), the American Urologic Association recommends evaluation of microscopic hematuria with cystoscopy in conjunction with upper urinary tract radiological imaging (particularly computed tomography [CT] urography).¹ Gross or macroscopic hematuria warrants a similar investigation, particularly owing to a greater likelihood of identifying underlying benign or malignant abnormalities.² Indeed, CT urography has the highest diagnostic yield in accurate diagnosis of upper tract urothelial carcinoma (UTUC) lesions albeit with inherent cost and radiation exposure.

Detection of Upper Tract Urothelial Malignancies by Computed Tomography Urography in Patients Referred for Hematuria at a Large Tertiary Referral Center

Abstract: Published online: January 12, 2017

 Objective

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.

Materials and Methods

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.

Results

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.

Conclusion

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.