Emily Bochner, Chidera Ibezue, Dev Banerji, Sarah Attia, Jacob Taylor, Yair Lotan
{"title":"评估肾脏超声在微量血尿评估中的诊断性能:AUA微量血尿2020指南的验证。","authors":"Emily Bochner, Chidera Ibezue, Dev Banerji, Sarah Attia, Jacob Taylor, Yair Lotan","doi":"10.1016/j.urology.2025.09.012","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To validate changes to the American Urological Association Microhematuria guidelines recommending ultrasound for low and intermediate-risk patients instead of cross-sectional imaging, we evaluated the performance of ultrasound in microhematuria evaluation in a large population with a new microhematuria event.</p><p><strong>Methods: </strong>After Institutional Review Board approval, medical records from a large community hospital were retrospectively queried for patients with new microhematuria and imaging performed during initial workup from January 2015 to April 2018. Follow-up imaging and subsequent diagnoses during the next 5 years (between 2018-2023) were evaluated for missed genitourinary cancer diagnoses.</p><p><strong>Results: </strong>A cohort of 5167 patients with microhematuria underwent imaging during initial workup. Forty-seven cancers were diagnosed on imaging: 32 kidney, 12 bladder, and 3 upper tract cancers. Approximately half of the cohort underwent renal ultrasound during initial workup. Most cancers were diagnosed on cross-sectional imaging. One bladder and 2 upper tract urothelial cancers identified on CT were missed on ultrasound. Five kidney cancers diagnosed on CT were missed on concurrent ultrasound (1.2%). In patients with a negative ultrasound during initial workup with follow-up cross-sectional imaging between 2018 and 2023 (n=401), 3 kidney cancers were diagnosed on subsequent imaging (0.75%). Median time to subsequent diagnosis was 398 days and all masses were cT1.</p><p><strong>Conclusion: </strong>In a large microhematuria population, renal ultrasound was frequently performed during initial workup with a rare missed or subsequent cancer diagnosis rate. Subsequent imaging after RUS was typically prompted by the development of symptoms, but follow-up studies showed early-stage disease, suggesting diagnosis was made in a timely fashion.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessing the Diagnostic Performance of Renal Ultrasound in Microhematuria Evaluation: Validation of the AUA Microhematuria 2020 Guidelines.\",\"authors\":\"Emily Bochner, Chidera Ibezue, Dev Banerji, Sarah Attia, Jacob Taylor, Yair Lotan\",\"doi\":\"10.1016/j.urology.2025.09.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To validate changes to the American Urological Association Microhematuria guidelines recommending ultrasound for low and intermediate-risk patients instead of cross-sectional imaging, we evaluated the performance of ultrasound in microhematuria evaluation in a large population with a new microhematuria event.</p><p><strong>Methods: </strong>After Institutional Review Board approval, medical records from a large community hospital were retrospectively queried for patients with new microhematuria and imaging performed during initial workup from January 2015 to April 2018. Follow-up imaging and subsequent diagnoses during the next 5 years (between 2018-2023) were evaluated for missed genitourinary cancer diagnoses.</p><p><strong>Results: </strong>A cohort of 5167 patients with microhematuria underwent imaging during initial workup. Forty-seven cancers were diagnosed on imaging: 32 kidney, 12 bladder, and 3 upper tract cancers. Approximately half of the cohort underwent renal ultrasound during initial workup. Most cancers were diagnosed on cross-sectional imaging. One bladder and 2 upper tract urothelial cancers identified on CT were missed on ultrasound. Five kidney cancers diagnosed on CT were missed on concurrent ultrasound (1.2%). In patients with a negative ultrasound during initial workup with follow-up cross-sectional imaging between 2018 and 2023 (n=401), 3 kidney cancers were diagnosed on subsequent imaging (0.75%). Median time to subsequent diagnosis was 398 days and all masses were cT1.</p><p><strong>Conclusion: </strong>In a large microhematuria population, renal ultrasound was frequently performed during initial workup with a rare missed or subsequent cancer diagnosis rate. Subsequent imaging after RUS was typically prompted by the development of symptoms, but follow-up studies showed early-stage disease, suggesting diagnosis was made in a timely fashion.</p>\",\"PeriodicalId\":23415,\"journal\":{\"name\":\"Urology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.urology.2025.09.012\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urology.2025.09.012","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Assessing the Diagnostic Performance of Renal Ultrasound in Microhematuria Evaluation: Validation of the AUA Microhematuria 2020 Guidelines.
Objective: To validate changes to the American Urological Association Microhematuria guidelines recommending ultrasound for low and intermediate-risk patients instead of cross-sectional imaging, we evaluated the performance of ultrasound in microhematuria evaluation in a large population with a new microhematuria event.
Methods: After Institutional Review Board approval, medical records from a large community hospital were retrospectively queried for patients with new microhematuria and imaging performed during initial workup from January 2015 to April 2018. Follow-up imaging and subsequent diagnoses during the next 5 years (between 2018-2023) were evaluated for missed genitourinary cancer diagnoses.
Results: A cohort of 5167 patients with microhematuria underwent imaging during initial workup. Forty-seven cancers were diagnosed on imaging: 32 kidney, 12 bladder, and 3 upper tract cancers. Approximately half of the cohort underwent renal ultrasound during initial workup. Most cancers were diagnosed on cross-sectional imaging. One bladder and 2 upper tract urothelial cancers identified on CT were missed on ultrasound. Five kidney cancers diagnosed on CT were missed on concurrent ultrasound (1.2%). In patients with a negative ultrasound during initial workup with follow-up cross-sectional imaging between 2018 and 2023 (n=401), 3 kidney cancers were diagnosed on subsequent imaging (0.75%). Median time to subsequent diagnosis was 398 days and all masses were cT1.
Conclusion: In a large microhematuria population, renal ultrasound was frequently performed during initial workup with a rare missed or subsequent cancer diagnosis rate. Subsequent imaging after RUS was typically prompted by the development of symptoms, but follow-up studies showed early-stage disease, suggesting diagnosis was made in a timely fashion.
期刊介绍:
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.