AUA 2019: IDENTIFY: The Investigation and Detection of Urological Neoplasia in Patients Referred with Suspected Urinary Tract Cancer: A Multicentre Analysis

Chicago, IL (  The diagnosis of a urologic neoplasm typically requires referral to a urologist. Dr. Sinan Khadhouri from Aberdeen Royal Infirmary presented his group’s work on a study evaluating the contemporary urologic malignancy rates and the performance of diagnostic tests in patients referred to a urologist for suspected urologic malignancy.

Khadhouri’s group prospectively collected 10,000 patient records from 111 hospitals in 28 countries from December 2018 to October 2018. Of the patients referred for secondary care for possible urologic neoplasms, 63.3% presented with gross hematuria, while 31.6% had microscopic hematuria. Furthermore, 5.1% of patients did not have gross or microscopic hematuria.

They found that the prevalence of bladder cancer during the study period was 14.2% in total. 18.1% of patients with gross hematuria were found to have bladder cancer, while 3.7% of microscopic hematuria patients were diagnosed with bladder cancer. 1% of referred patients had upper tract urothelial carcinoma, while 0.9% had renal cell carcinoma and 1.2% of patients had prostate cancer. They found that bladder cancer and upper tract urothelial carcinoma prevalence was greatest in the 70-79 age group and was expectedly higher in males. They found that risk factors for a bladder cancer diagnosis included gross hematuria, age, smoking history, anticoagulation, lower urinary tract symptoms, and having more than one episode of gross hematuria.

They also evaluated the sensitivity, specificity, and negative and positive predictive values (PPV/NPV) of ultrasound (US) and contrast-enhanced CT for the diagnosis of both bladder cancer and upper tract urothelial cancer. They found that for bladder cancer,  US had a 67.8% 67.8% PPV and 96.0% NPV, while CT had a 71.5% PPV, and a 95.2% NPV. For upper tract urothelial carcinoma, the US had a 12.7% PPV and a 99.5% NPV, while CT had a 26.8% PPV and a 99.9% NPV (Table 1).

The group concluded that this study provides a contemporary rate of urinary tract malignancy detection in a worldwide population and can help physicians develop a more personalized approach to the evaluation of patients presenting with suspected urologic malignancy.

AUA 2019 table 1 test characteristics

Presented by: Sinan Khadhouri, MBBS, Aberdeen Royal Infirmary, Aberdeen University, Aberdeen, United Kingdom

Written By: Brian Kadow, MD. Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA. @btkmduro at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois