EAU 2019: IDENTIFY: The Investigation and Detection of Urological Neoplasia in Patients Referred with Suspected Urinary Tract Cancer

Barcelona, Spain (UroToday.com) Investigation of hematuria is resource intensive, burdensome and involves invasive tests, often with a low cancer diagnostic yield. Although there are several hematuria guidelines, they are often cumbersome and leave discretion to the provider; workup typically is dictated by patient age, comorbidities, smoking history, etc. Dr. Khadhouri and colleagues discussed the IDENTIFY study, which aims to determine contemporary urinary tract cancer rates and diagnostic test performance in patients referred to secondary care with suspected urothelial cancer.

IDENTIFY is the largest prospective, international, multi-centre study of patients referred to secondary care, with or without hematuria, for the investigation of suspected urinary tract cancer. Patient demographics, presenting features and diagnostic test results were recorded. Prevalence rates were calculated for each subtype of urological cancer and diagnostic test accuracies were calculated. There were 11,060 patient records collected from 128 hospitals in 30 countries from December 2017-2018). The distribution of sites is as follows:
EAU2019 UroToday IDENTIFY 1
Among records assessed, 65% of patients presented with visible hematuria, 29% with non-visible hematuria and 6% without hematuria. The prevalence of bladder cancer overall was 17.7%; 18.1% in visible hematuria, 3.7% in non-visible hematuria and 26.6% in no hematuria. Not surprisingly, 81.5% of bladder cancers presented with visible hematuria.  Upper tract urothelial cancer prevalence was 1.15%, renal cell carcinoma 0.98% and prostate cancer 1.18%. Variables significantly associated with bladder cancer included type of hematuria, age, smoking history, anticoagulation, storage urinary tract symptoms and having had >1 episode of visible hematuria (25.5%) vs. only 1 (17.9%). Upper tract urothelial carcinoma was significantly associated with type of hematuria, age, smoking history and anticoagulation. The rate of bladder cancer found in those with culture proven urinary tract infection was 7.0%. The diagnostic performance of ultrasound and Computed Tomography is as follows:
EAU2019 UroToday IDENTIFY 1

This initiative is excellent and the authors should be commended for their effort. Further delineating diagnostic patterns among patients with occult malignancy will certainly inform future guidelines. Future work stratifying by region will be important.

The authors concluded that IDENTIFY provides contemporary cancer detection rates in a global population alongside diagnostic test performance for each cancer type. The extensive data will improve shared decision-making by developing predictive models to optimize cancer detection. These patient-specific pathways will reduce patient and healthcare resource burdens.

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

Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University - Medical College of Georgia Twitter: @zklaassen_md at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona Spain, March 15-19, 2019.