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Accuracy of ultrasound vs computed tomography scan for upper urinary tract malignancies and development of a risk-based diagnostic algorithm for haematuria in a UK tertiary centre

  • Urology - Original Paper
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Abstract

Purpose

There is no consensus across guidelines on a diagnostic algorithm for upper urinary tract (UUT) evaluation following presentation with haematuria. Our aim is to compare the diagnostic accuracy of ultrasound (USS) compared to CT-scan for UUT malignancies and also determine the considerations important for a risk-based diagnostic protocol for haematuria.

Methods

We reviewed our ‘haematuria clinic’ database to identify patients who had both USS and CT-scan for UUT evaluation between September 2015 and August 2017, and calculated the diagnostic accuracy of these imaging modalities for histologically confirmed UUT cancers. Furthermore, we identified risk factors in our diagnostic algorithm for haematuria and conducted regression analysis to determine their ability to predict UUT malignancies.

Results

Overall, 575 patient records were studied. Age range was 21–92 years, M:F was 1.4:1, majority (81.2%) had visible haematuria, and 12 (2.1%) UUT cancers were diagnosed [renal cell carcinoma—1.4%; upper tract urothelial cancer—0.7%]. USS and CT-scan had diagnostic accuracy for UUT cancers of 95.8 and 99.1%, respectively (p < 0.001). Haematuria type was a significant consideration only on univariate analysis, while multivariate binary logistic regression showed that male gender, smoking, occupational exposure, and positive urologic history were the main risk factors associated with UUT malignancies.

Conclusion

USS and CT-scan have comparably high diagnostic accuracy for detecting UUT malignancies. USS may, therefore, be considered as the first-line UUT imaging modality when utilized in a risk-based diagnostic algorithm. Larger, multicentred studies are needed to validate our findings and influence guideline development.

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Funding

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Author notes

  1. Rotimi A. David

    Present address: Urology Department, Royal Bournemouth Hospital, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK

Authors and Affiliations

  1. Urology Department, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK

    Rotimi A. David, B. James, P. Bose & G. V. KandaSwamy

  2. Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK

    D. Adeloye

  3. Urology Department, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK

    B. Rai

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Contributions

All the authors have contributed to this study in ways that conform to ICMJE authorship criteria. RAD and BJ retrieved the data. RAD and DA carried out the statistical analysis. All authors had input in the article draft/revision and approved the final version of the manuscript.

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Correspondence to Rotimi A. David.

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Ethical approval

This study was approved by the clinical audit and effectiveness department of our hospital, and was conducted in accordance with the ethical standards stated in the 1964 Helsinki declaration and its later amendments.

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This study involved a retroactive review of de-identified data from an electronic database, so informed consent was waived.

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David, R.A., James, B., Adeloye, D. et al. Accuracy of ultrasound vs computed tomography scan for upper urinary tract malignancies and development of a risk-based diagnostic algorithm for haematuria in a UK tertiary centre. Int Urol Nephrol 53, 49–57 (2021). https://doi.org/10.1007/s11255-020-02615-7

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