Hematuria Cancer Risk Score with Ultrasound Informs Cystoscopy Use in Patients with Hematuria.

Autor: Tan WS; Department of Urology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Division of Surgery and Interventional Science, University College London, London, UK. Electronic address: wstan@mdanderson.org., Ahmad A; Division of Surgery and Interventional Science, University College London, London, UK; Cancer Intelligence, Cancer Research UK, London, UK., Zhou Y; Department of Public health and Primary Care, University of Cambridge, Cambridge, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK., Nathan A; Department of Urology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Department of Urology, Royal Free Hospital, London, UK., Ogunbo A; Department of Urology, Royal Free Hospital, London, UK., Gbolahan O; Department of Urology, Royal Free Hospital, London, UK., Kallam N; Department of Urology, Royal Free Hospital, London, UK., Smith R; Department of Urology, Royal Free Hospital, London, UK., Khalifeh M; Department of Urology, Royal Free Hospital, London, UK., Tan WP; Department of Urology, New York University Langone Health, New York City, NY, USA., Cohen D; Department of Urology, Royal Free Hospital, London, UK., Volanis D; Department of Urology, Royal Free Hospital, London, UK., Walter FM; Department of Public health and Primary Care, University of Cambridge, Cambridge, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK., Sasieni P; Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Innovation Hub, Guys Cancer Centre, Guys Hospital, King's College London, London, UK., Kamat AM; Division of Surgery and Interventional Science, University College London, London, UK., Kelly JD; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals, London, UK.
Jazyk: angličtina
Zdroj: European urology oncology [Eur Urol Oncol] 2024 May 28. Date of Electronic Publication: 2024 May 28.
DOI: 10.1016/j.euo.2024.05.005
Abstrakt: Background: Hematuria is a cardinal symptom of urinary tract cancer and would require further investigations.
Objective: To determine the ability of renal bladder ultrasound (RBUS) with the Hematuria Cancer Risk Score (HCRS) to inform cystoscopy use in patients with hematuria.
Design, Setting, and Participants: The development cohort comprised 1984 patients with hematuria from 40 UK hospitals (DETECT 1; ClinicalTrials.gov: NCT02676180) who received RBUS. An independent validation cohort comprised 500 consecutive patients referred to secondary care for a suspicion of bladder cancer.
Outcome Measurements and Statistical Analysis: Sensitivity and true negative of the HCRS and RBUS were assessed.
Results and Limitations: A total of 134 (7%) and 36 (8%) patients in the development and validation cohorts, respectively, had a diagnosis of urinary tract cancer. Validation of the HCRS achieves good discrimination with an area under the receiver operating characteristic curve of 0.727 (95% confidence interval 0.648-0.800) in the validation cohort with sensitivity of 95% for the identification of cancer. Utilizing the cutoff of 4.500 derived from the HCRS in combination with RBUS in the development cohort, 680 (34%) patients would have been spared cystoscopy at the cost of missing a G1 Ta bladder cancer and a urinary tract cancer patient, while 117 (25%) patients would have avoided cystoscopy at the cost of missing a single patient of G1 Ta bladder cancer with sensitivity for the identification of cancer of 97% in the validation cohort.
Conclusions: The HCRS with RBUS offers good discriminatory ability in identifying patients who would benefit from cystoscopy, sparing selected patient cohorts from an invasive procedure.
Patient Summary: The hematuria cancer risk score with renal bladder ultrasound allows for the triage of patients with hematuria who would benefit from visual examination of the bladder (cystoscopy). This resulted in 25% of patients safely omitting cystoscopy, which is an invasive procedure, and would lead to health care cost savings.
(Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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