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.
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.