Non-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis.

Autor: Jubber I; Academic Urology Unit, University of Sheffield, Sheffield, UK., Shariat SF; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Conroy S; Academic Urology Unit, University of Sheffield, Sheffield, UK., Tan WS; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, London, UK., Gordon PC; Department of Urology, Sheffield Teaching Hospital NHS Trust, Sheffield, UK., Lotan Y; Department of Urology, University of Texas Southwestern, Dallas, TX, USA., Messing EM; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA., Stenzl A; Department of Urology, University of Tübingen Medical School, Tübingen, Germany., Rhijn BV; Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Kelly JD; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals, London, UK., Catto JWF; Academic Urology Unit, University of Sheffield, Sheffield, UK., Cumberbatch MG; Academic Urology Unit, University of Sheffield, Sheffield, UK. Electronic address: m.g.cumberbatch@sheffield.ac.uk.
Jazyk: angličtina
Zdroj: European urology [Eur Urol] 2020 May; Vol. 77 (5), pp. 583-598. Date of Electronic Publication: 2019 Nov 30.
DOI: 10.1016/j.eururo.2019.10.010
Abstrakt: Context: Non-visible haematuria (NVH) is a common finding and may indicate undiagnosed urological cancer. The optimal investigation of NVH is unclear, given the incidence of cancer and the public health implications of testing all individuals with this finding.
Objective: We review contemporary literature to determine the association of NVH with the diagnosis of bladder cancer (BC), upper tract urothelial carcinoma (UTUC), and kidney cancer (KC).
Evidence Acquisition: A systematic review of original articles in English was completed in May 2019. Meta-analyses for the diagnostic accuracy of NVH and urine cytology were performed.
Evidence Synthesis: We screened 1529 articles and selected 78 manuscripts that fulfilled our inclusion criteria for narrative synthesis. Forty manuscripts were eligible for a meta-analysis (reporting 19 193 persons). The likelihood of a urological cancer in patients with NVH increased with age (<1% in those aged <40yr), male sex, and cigarette smoking. Less than 1% of patients are found to have a urological cancer after a negative NVH evaluation. Cancer detection rates in individuals evaluated for NVH ranged from 0% to 16% for BC in 37 studies, 0% to 3.5% for UTUC in 30 studies, and 0% to 9.7% for KC in 29 studies. Substantial statistical heterogeneity was present for the meta-analysis of detection rates.
Conclusions: We present an up-to-date review of the association of NVH with the diagnosis of BC, UTUC, and KC. Individuals with dipstick positive haematuria aged ≥40yr, who have had potential precipitating causes excluded, should undergo an evaluation. Re-evaluation of patients with unremarkable initial investigations should be performed in high-risk patients or if new symptoms occur.
Patient Summary: One in five people have microscopic traces of blood in their urine. This is an important indicator of urological cancer. Investigating all patients is uncomfortable and expensive. We evaluate the risk of cancer and estimate risks to groups of individuals.
(Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: