The test cohort consisted of 2630 patients, of whom 55 (2.1%) had a neoplasm detected and 50 (1.9%) had a pathologically confirmed urinary tract cancer. The strongest predictors of cancer were age of 50 years or older and a recent diagnosis of gross hematuria. Male sex was also predictive of cancer, whereas smoking history and 25 or more red blood cells per high-power field on a recent urinalysis were not statistically significant.
The findings were used to create a Hematuria Risk Index to predict cancer risk and performed comparably in the validation cohort of 1784 patients. Overall, 32% of the population was identified as low risk and 0.2% had a cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer found.
"These data confirm that a large number of follow-up examinations could be safely avoided," observes senior investigator Steven J. Jacobsen, MD, PhD, Kaiser Permanente Southern California, Pasadena, California. "They suggest that microscopic hematuria is an unreliable indicator of urinary tract malignant tumors. Patients with microscopic hematuria younger than 50 years and with no history of gross hematuria may not benefit from further evaluation and therefore could avoid unnecessary risk from radiation exposure and invasive endoscopy. These findings may be used to simplify referral guidelines for evaluation in asymptomatic patients with microscopic hematuria and reduce the number of unnecessary evaluations."
|Contact: Rachael Zaleski|
Elsevier Health Sciences