title: Detection of Upper Tract Urothelial Malignancies by Computed Tomography Urography in Patients Referred for Hematuria at a Large Tertiary Referral Center.
abstract: To evaluate the age-stratified prevalence of upper tract urothelial malignancies diagnosed on computed tomography urography in a large cohort of patients referred for initial evaluation of hematuria.
  
  
  
  A total of 1123 consecutive adults without a history of urothelial cancer underwent initial computed tomography urography for gross hematuria (n = 652), microscopic hematuria (n = 457), or unspecified hematuria (n = 14) at a single institution from October 2006 to October 2012. Imaging findings suggestive of urothelial lesions were correlated with clinical information, including cystoscopy, cytology, and surgical pathology reports. Patients subsequently diagnosed with urothelial cancer following a normal radiographic evaluation were identified and analyzed. Age, gender, smoking history, and location and type of malignancy were analyzed.
  
  
  
  Upper tract urothelial cancer was detected in 4 (0.36%) patients, with a mean age of 66.5 years. All 4 patients presented with gross hematuria and were current or former smokers. None of the 535 patients under age 55 who underwent computed tomography urography were diagnosed with upper tract disease regardless of age, smoking history, or degree of hematuria. Likewise, no upper tract cancers were detected in patients referred for microscopic hematuria, regardless of age.
  
  
  
  Detection of upper tract urothelial cancer by computed tomography urography is exceedingly rare in patients presenting at a tertiary referral center with hematuria, particularly in the lower risk strata (younger age, microscopic hematuria). Further investigation into risk-stratified approaches to imaging for hematuria workup is warranted to minimize unnecessary costs and radiation exposure.
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Clayton W
authors.initials: CW
authors.lastname: Commander
authors.affiliation: Department of Urology, University of North Carolina, Chapel Hill, NC.
authors.forename: David C
authors.initials: DC
authors.lastname: Johnson
authors.affiliation: Department of Urology, University of North Carolina, Chapel Hill, NC. Electronic address: mathew_raynor@med.unc.edu.
authors.forename: Mathew C
authors.initials: MC
authors.lastname: Raynor
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Burke
authors.affiliation: Department of Urology, University of North Carolina, Chapel Hill, NC.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Hacker
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Bryan
authors.initials: B
authors.lastname: Hoag
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Julia R
authors.initials: JR
authors.lastname: Fielding
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Semelka
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Ellie R
authors.initials: ER
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D014516:Ureteral Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014567:Urography / Q000379:methods