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。

IF 2 3区 医学 Q2 UROLOGY & NEPHROLOGY
Emily Bochner, Chidera Ibezue, Dev Banerji, Sarah Attia, Jacob Taylor, Yair Lotan
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引用次数: 0

摘要

目的:为了验证美国泌尿学会微血尿指南的改变,该指南推荐对中低风险患者使用超声而不是横断成像,我们评估了超声在大量新出现微血尿事件的人群中评估微血尿的性能。方法:经机构审查委员会批准,回顾性查询一家大型社区医院2015年1月至2018年4月首次工作期间新发微量血尿患者的病历和影像学检查。对未来5年(2018-2023年)的随访影像和后续诊断进行评估,以确定是否遗漏了泌尿生殖系统癌的诊断。结果:5167例微血尿患者在初始检查时接受了影像学检查。47例肿瘤影像学诊断为:32例肾癌,12例膀胱癌,3例上尿道癌。大约一半的队列在初始检查时接受了肾脏超声检查。大多数癌症是通过横断面成像诊断的。1例膀胱癌和2例上尿路上皮癌在CT上被遗漏。CT诊断为肾癌的同时超声漏诊5例(1.2%)。在2018-2023年期间的初始检查和随访横断面成像期间超声阴性的患者中(n=401),随后的成像诊断为3例肾癌(0.75%)。中位诊断时间为398天,所有肿块均为cT1。结论:在大量微量血尿人群中,肾脏超声检查经常在初始检查中进行,漏诊率或随后的癌症诊断率很少。RUS后的后续成像通常是由症状的发展引起的,但随访研究显示疾病处于早期阶段,提示诊断及时。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
Urology
Urology 医学-泌尿学与肾脏学
CiteScore
3.30
自引率
9.50%
发文量
716
审稿时长
59 days
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.
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