Impact of Hematuria Risk-Stratification Guidelines on CT Urography Detection of Upper Urinary Tract Malignancy.
Objectives and Hypothesis: CT urography (CTU) is a preferred diagnostic modality in hematuria evaluation and has the highest sensitivity and specificity for upper urinary tract malignancy, including renal cell carcinoma and upper tract urothelial carcinoma. Recent guidelines offer differing approach...
| Publicado en: | Applied Radiology Vol. 55; no. 1; pp. 21 - 30 |
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| Autores principales: | , , , |
| Formato: | practice guidelines research tables/charts Journal Article |
| Publicado: |
Anderson Publishing Ltd.
Jan2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=191474458&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 191474458 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01609963 45A jtl: Applied Radiology issn: 01609963 maglogo: N pubinfo: dt: Jan2026 vid: 55 iid: 1 pid: 6733 pub: Anderson Publishing Ltd. place: Scotch Plains, New Jersey artinfo: ui: 191474458 191474458 191474458 10.37549/AR-D-25-0148 191474458 ppf: 21 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Impact of Hematuria Risk-Stratification Guidelines on CT Urography Detection of Upper Urinary Tract Malignancy. aug: au: Rumball, Ian Arenz, Andrea A. Bennie, Barbara A. Riherd, Jody affil: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin sug: subj: Urologic Neoplasms Diagnosis Hematuria Risk Factors Risk Assessment Urography Methods Tomography, X-Ray Computed Sensitivity and Specificity Carcinoma, Renal Cell Diagnosis Practice Guidelines Human United States Male Female Middle Age Aged Retrospective Design Record Review Nonexperimental Studies Descriptive Statistics Pearson's Correlation Coefficient Chi Square Test Fisher's Exact Test Post Hoc Analysis Data Analysis Software Cancer Patients Early Detection of Cancer Decision Making, Clinical Reference Books Radiologic Health Urography Utilization Radiation Injuries Health Care Costs False Positive Results Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Objectives and Hypothesis: CT urography (CTU) is a preferred diagnostic modality in hematuria evaluation and has the highest sensitivity and specificity for upper urinary tract malignancy, including renal cell carcinoma and upper tract urothelial carcinoma. Recent guidelines offer differing approaches to risk stratification of patients with hematuria, which may affect malignancy detection and CTU use. We hypothesize that among CTUs obtained for hematuria, there will be increased diagnostic yield for upper tract malignancy for imaging obtained in accordance with recent risk-stratification guidelines. Materials and Methods: This retrospective observational study assessed patients who underwent primary CTU for hematuria at a rural health system between January 1, 2021, and July 31, 2023. Cases were divided into microscopic and gross hematuria, and risk-stratified according to the 2020 American Urologic Association (AUA), 2023 Dutch Urological Association (DUA), and 2025 AUA guidelines. CTU, cystoscopy, and pathology reports were reviewed. Prevalence and diagnostic yield between subgroups were compared with appropriate statistical analyses. Results: Among 969 patients (mean age 65 years), CTU detected pathologically confirmed upper tract malignancy in 28 (2.9%). Diagnostic yield was not significantly higher among CTUs performed in concordance with the 2020 AUA (3.2% vs 0%; P = .4), 2023 DUA (3.4% vs 2.2%; P = .4), and 2025 AUA (3.4% vs 0%; P = .1) guidelines. Of the 274 patients for whom CTU was not recommended by the DUA guidelines, 6 had pathologically confirmed upper tract malignancy, contrasted with none for the AUA 2020 and 2025 guidelines. Conclusions: Application of risk-stratification guidelines did not significantly improve diagnostic yield of CTU detection for upper tract malignancy among patients presenting with hematuria. Despite this, risk-stratification approaches are likely warranted given poor yield in low-risk populations. Guidelines differed in the rate of recommended CTU use and the number of cases of potentially nonimaged upper tract malignancies. pubtype: Academic Journal doctype: practice guidelines research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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