Examining the upper urinary tract in patients with hematuria-time to revise the CT urography protocol?
Examining the upper urinary tract in patients with hematuria-time to revise the CT urography protocol?
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DOI：
10.1007/s00330-019-06521-0
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发表时间：
2020-03-01
影响因子：
5.9
通讯作者：
Sandbaek, Gunnar
中科院分区：
文献类型：
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作者：
Rud, Erik;Galtung, Kristina Flor;Sandbaek, Gunnar
背景：三相CT尿路造影（CTU）是血尿患者评价上尿路的金标准。我们的目的是评估CTU在血尿和膀胱镜检查阴性患者中检测上尿路上皮细胞癌（UCC）的准确性。其次，我们的目的是确定肿瘤在每个CTU阶段的可见性。材料和方法本回顾性研究包括2016年至2017年期间膀胱镜检查阴性后转诊至CTU的所有血尿患者。CTU最初的报告分为正面和负面两种。在至少18个月的随访后，对所有患者的图表进行了审查，以登记遗漏的癌症。以活检及临床随访结果为参考标准。两位研究者回顾性地评估了所有真阳性CT病例中每个CT序列的肿瘤可见性。结果我们纳入了376例在膀胱镜检查阴性后接受CTU检查的血尿患者。肉眼和显微镜下血尿发生率分别为87%（327例）和13%（49例）。上尿路上皮细胞癌的发生率为1.9% (7)，CTU的敏感性为100% (95% CI, 59-100)，特异性为99% (95% CI, 98-100)，阳性预测值为88% (95% CI, 47-99)，阴性预测值为100% （95% CI, 99-100）。准确率为99% （95% CI, 90-100）。两位审稿人在肾造影阶段均可见所有ucc。结论CTU对上肢UCCs的检测具有较高的准确性。所有病例均出现肾造影期。这说明CTU协议可以简化。
Background Three-phase CT urography (CTU) is the gold standard for evaluating the upper urinary tract in patients with hematuria. We aimed to evaluate the accuracy of CTU for detecting upper urothelial cell carcinomas (UCC) in patients with hematuria and negative cystoscopy. Secondly, we aimed to determine the tumor visibility on each CTU phase. Material and methods This retrospective study included all patients with hematuria referred to CTU after a negative cystoscopy during 2016 and 2017. The original CTU reports were dichotomized as negative or positive. All patient charts were reviewed after a minimum of 18-month follow-up in order to register missed cancers. The results of biopsies and clinical follow-up were used as the reference standard. Two reviewers retrospectively evaluated the tumor visibility of each CT sequence in all true-positive CTUs. Results We included 376 patients with hematuria who underwent CTU after a negative cystoscopy. Macroscopic and microscopic hematuria occurred in 87% (327) and 13% (49), respectively. The incidence of upper urothelial cell carcinoma was 1.9% (7), and the sensitivity of CTU was 100% (95% CI, 59-100), specificity was 99% (95% CI, 98-100), positive predictive value was 88% (95% CI, 47-99), and negative predictive value was 100% (95% CI, 99-100). The accuracy was 99% (95% CI, 90-100). All UCCs were visible on the nephrographic phase for both reviewers. Conclusion CTU is highly accurate for detecting upper UCCs. All cases were seen on the nephrographic phase. This suggests that the CTU protocol can be simplified.