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The following is a summary of “Diagnostic yield of upper tract imaging performed for hematuria screening: Results from a national, privately-insured cohort,” published in the January 2024  issue of Urology by Ballon-Landa, et al.

For a study, researchers sought to help more people understand how to use upper tract imaging during risk-based hematuria screening. They looked at the rates of imaging and the diagnostic results of each imaging technique using a national sample of people with private insurance. They thought that the number of cases of upper tract disease would be low and that computed tomography would not be much better than kidney ultrasound.

They searched the MarketScan database to find people diagnosed with tiny or gross hematuria between 2010 and 2015. Multivariable logistic regression was used to determine the odds of any upper tract result with a group study that only looked at cancerous outcomes.

Of the 466,710 people they found, 150,880 (32.3%) had an ultrasound, 219,449 (47.0%) had a computed tomography, and 96,381 (20.7%) had some other kind of imaging. Out of 150,880 patients, ultrasound found 1,469 findings (1%); CT scans found 3,764 findings in 219,449 patients (1.7%); and other imaging found 2,612 findings in 96,381 patients (2.7%) (P < 0.0001). In the general and group analyses, results in the upper tract were linked to older age, being male, having a higher Elixhauser index, having gross hematuria, and having CT or other imaging (all P< 0.0001). Imaging has a higher diagnostic output than expected, but the discovery rate stayed low. As new clinical practice standards state, doctors should use risk-based imaging methods when checking for hematuria. However, these results support using ultrasound more at the start of the evaluation.

Source: sciencedirect.com/science/article/abs/pii/S1078143923003046