Computed tomography for visible haematuria – a single nephrographic phase is sufficient for detecting renal cell carcinoma

Authors

  • Kristina Flor Galtung Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
  • Peter Mæhre Lauritzen Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
  • Gunnar Sandbæk Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
  • Dag Bay Department of Radiology, Oslo University Hospital, Oslo, Norway
  • Erica Ponzi Department of Research Support for Clinical Trials, Clinical Trial Unit, Oslo University Hospital, Oslo, Norway; Oslo Center for Biostatistics and Epidemiology (OCBE), Department of Biostatistics, University of Oslo, Oslo, Norway
  • Eduard Baco Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway.
  • Nigel Christopher Cowan Department of Radiology, Portsmouth Hospitals University NHS Trust, UK
  • Anca Mihaela Naas Department of Pathology, Oslo University Hospital, Oslo, Norway
  • Erik Rud Department of Radiology, Oslo University Hospital, Oslo, Norway

DOI:

https://doi.org/10.2340/sju.v59.18467

Keywords:

Hematuria, Multidetector Computed Tomography, Prospective Study, Renal Cell Carcinoma

Abstract

Objectives: No previous studies have compared two computed tomography (CT) protocols in patients presenting with visible haematuria, and most patients undergo a multiphase CT in order to detect upper tract malignancies. We aimed to prospectively compare the diagnostic performance of single- and four-phase CT for detecting renal cell carcinoma (RCC) in patients with visible haematuria.

Materials & methods: ‘A Prospective Trial for Examining Hematuria using Computed Tomography’ (PROTEHCT) was a single-centre prospective paired diagnostic study in patients referred for CT due to painless visible haematuria between September 2019 and June 2021. All patients underwent four-phase CT (control) from which a single nephrographic phase dual energy CT (experimental) was extracted. Both were independently assessed for RCC by randomised radiologists. Histologically verified RCC defined a positive reference standard. Follow-up ascertainment of RCC diagnosis was completed in May 2022. Descriptive statistics were used to calculate the accuracies. Inter-reader agreement was assessed by kappa statistics.

Results: A total of 308 patients (median age, 68 years [interquartile range 53–77, range 18–96], 250 males) were included for analysis. RCC was diagnosed in seven (2.3%) patients during a median follow-up time of 19 months (interquartile range: 15–25). For the control and experimental CT, sensitivity was 100% versus 100%, specificity was 97% versus 98% and accuracy 97% versus 97%. The positive predictive value was 44% versus 50%, and the negative predictive value was 100% versus 100%. The agreement between the control and experimental CT was 98% (k = 0.79).

Conclusion: A single nephrographic phase dual energy CT is sufficient for detecting RCC in patients with visible haematuria.

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References

Tan WS, Feber A, Sarpong R, et al. Who should be investigated for haematuria? Results of a contemporary prospective observational study of 3556 patients. Eur Urol. 2018;74(1):10–14.

https://doi.org/10.1016/j.eururo.2018.03.008 DOI: https://doi.org/10.1016/j.eururo.2018.03.008

Fankhauser CD, Waisbrod S, Fierz C, et al. Diagnostic accuracy of ultrasonography, computed tomography, cystoscopy and cytology to detect urinary tract malignancies in patients with asymptomatic hematuria. World J Urol. 2021;39(1):97–103.

https://doi.org/10.1007/s00345-020-03171-6 DOI: https://doi.org/10.1007/s00345-020-03171-6

Rai BP, Escrig JLD, Vale L, et al. Systematic review of the incidence of and risk factors for urothelial cancers and renal cell carcinoma among patients with hae-maturia. Eur Urol. 2022;82(2):182–192.

https://doi.org/10.1016/j.eururo.2022.03.027 DOI: https://doi.org/10.1016/j.eururo.2022.03.027

Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology guidelines on renal cell carcinoma: the 2022 update. Eur Urol. 2022;82(4):399–410.

https://doi.org/10.1016/j.eururo.2022.03.006 DOI: https://doi.org/10.1016/j.eururo.2022.03.006

Rouprêt M, Seisen T, Birtle AJ, et al. European Association of Urology guidelines on upper urinary tract urothelial carcinoma: 2023 update. Eur Urol. 2023;84(1):49–64.

https://doi.org/10.1016/j.eururo.2023.03.013 DOI: https://doi.org/10.1016/j.eururo.2023.03.013

Georgieva MV, Wheeler SB, Erim D, et al. Comparison of the harms,

advantages, and costs associated with alternative guidelines for the evaluation of hematuria. JAMA Intern Med. 2019;179(10):1352–1362.

https://doi.org/10.1001/jamainternmed.2019.2280 DOI: https://doi.org/10.1001/jamainternmed.2019.2280

Bromage SJ, Liew MPC, Moore KC, Raju B, Shackley DC. The economic implications of unsuspected findings from CT urography performed for haematuria. Br J Radiol. 2012;85(1017):1303–1306.

https://doi.org/10.1259/bjr/96070557 DOI: https://doi.org/10.1259/bjr/96070557

Galtung KF, Lauritzen PM, Sandbæk G, et al. Is a single nephrographic phase computed tomography sufficient for detecting urothelial carcinoma in patients with visible haematuria? A prospective paired noninferiority comparison. Eur Urol Open Sci. 2023;55:1–10.

https://doi.org/10.1016/j.euros.2023.06.005 DOI: https://doi.org/10.1016/j.euros.2023.06.005

Szolar DH, Kammerhuber F, Altziebler S, et al. Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (< 3-cm) renal masses. Radiology. 1997;202(1):211–217.

https://doi.org/10.1148/radiology.202.1.8988213 DOI: https://doi.org/10.1148/radiology.202.1.8988213

Birnbaum BA, Jacobs JE, Ramchandani P. Multiphasic renal CT: comparison of renal mass enhancement during the corticomedullary and nephrographic phases. Radiology. 1996;200(3):753–758.

https://doi.org/10.1148/radiology.200.3.8756927 DOI: https://doi.org/10.1148/radiology.200.3.8756927

Songib NA, Nazri M, Yaakup NA, Nor HM, Sun Z. Multiphase renal CT in the evaluation of renal masses: is the nephrographic phase necessary? Clin Imaging. 2013;37(6):1037–1042.

https://doi.org/10.1016/j.clinimag.2013.08.005 DOI: https://doi.org/10.1016/j.clinimag.2013.08.005

Kopka L, Fischer U, Zoeller G, Schmidt C, Ringert RH, Grabbe E. Dual-phase helical CT of the kidney: value of the corticomedullary and nephrographic phase for evaluation of renal lesions and preoperative staging of renal cell carcinoma. J Urology. 1998;160(4):1586–1587.

https://doi.org/10.1016/S0022-5347(01)62634-X DOI: https://doi.org/10.1016/S0022-5347(01)62634-X

Yuh BI, Cohan RH, Francis IR, Korobkin M, Ellis JH. Comparison of nephrographic with excretory phase helical computed tomography for detecting and character-izing renal masses. Can Assoc Radiol J. 2000;51(3):170–176.

Silverman SG, Pedrosa I, Ellis JH, et al. Bosniak classification of cystic renal masses, version 2019: an update proposal and needs assessment. Radiology. 2019;292(2):182646.

https://doi.org/10.1148/radiol.2019182646 DOI: https://doi.org/10.1148/radiol.2019182646

Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc. 1927;22(158):209–212.

https://doi.org/10.1080/01621459.1927.10502953 DOI: https://doi.org/10.1080/01621459.1927.10502953

Newcombe RG. Two‐sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17(8):857–872. DOI: https://doi.org/10.1002/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-E

https://doi.org/10.1002/(SICI)1097-0258(19980430)17:8%3C857::AID-SIM777%3E3.0.CO;2-E

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric ap-proach. Biometrics. 1988;44(3):837–845.

https://doi.org/10.2307/2531595 DOI: https://doi.org/10.2307/2531595

Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics 1977;33:159.

https://doi.org/10.2307/2529310. DOI: https://doi.org/10.2307/2529310

Rud E, Galtung KF, Lauritzen PM, Baco E, Flatabø T, Sandbæk G. Examining the upper urinary tract in patients with hematuria – time to revise the CT urography protocol? Eur Radiol. 2020;30(3):1664–1670.

https://doi.org/10.1007/s00330-019-06521-0 DOI: https://doi.org/10.1007/s00330-019-06521-0

Vogel C, Ziegelmüller B, Ljungberg B, et al. Imaging in suspected renal-cell carcinoma: systematic review. Clin Genitourin Canc. 2019;17(2):e345–e355.

https://doi.org/10.1016/j.clgc.2018.07.024 DOI: https://doi.org/10.1016/j.clgc.2018.07.024

Rossi SH, Prezzi D, Kelly-Morland C, Goh V. Imaging for the diagnosis and response assessment of renal tumours. World J Urol. 2018;36(12):1927–1942.

https://doi.org/10.1007/s00345-018-2342-3 DOI: https://doi.org/10.1007/s00345-018-2342-3

Choudhary S, Rajesh A, Mayer NJ, Mulcahy KA, Haroon A. Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms. Clin Radiol. 2009;64(5):517–522.

https://doi.org/10.1016/j.crad.2008.12.011 DOI: https://doi.org/10.1016/j.crad.2008.12.011

Kang SK, Huang WC, Pandharipande PV, Chandarana H. Solid renal masses: what the numbers tell us. Am J Roentgenol. 2014;202(6):1196–1206.

https://doi.org/10.2214/AJR.14.12502 DOI: https://doi.org/10.2214/AJR.14.12502

Meyer HJ, Pfeil A, Schramm D, Bach AG, Surov A. Renal incidental findings on computed tomography. Medicine. 2017;96(26):e7039.

https://doi.org/10.1097/MD.0000000000007039 DOI: https://doi.org/10.1097/MD.0000000000007039

Warren AY, Harrison D. WHO/ISUP classification, grading and pathological staging of renal cell carcinoma: standards and controversies. World J Urol. 2018;36(12):1913–1926.

https://doi.org/10.1007/s00345-018-2447-8 DOI: https://doi.org/10.1007/s00345-018-2447-8

Nazzani S, Zaborra C, Biasoni D, et al. Renal tumor biopsy in patients

with cT1b-T4-M0 disease susceptible to radical nephrectomy: analysis of safety, accuracy and clinical impact on definitive management. Scand J Urol. 2022;56(5–6):367–372.

https://doi.org/10.1080/21681805.2022.2092549 DOI: https://doi.org/10.1080/21681805.2022.2092549

Lee-Felker SA, Felker ER, Tan N, et al. Qualitative and quantitative MDCT features for differentiating clear cell renal cell carcinoma from other solid renal cortical masses. AJR Am J Roentgenol. 2014;203(5):W516–W524.

https://doi.org/10.2214/AJR.14.12460 DOI: https://doi.org/10.2214/AJR.14.12460

Raman SP, Johnson PT, Allaf ME, Netto G, Fishman EK. Chromophobe renal cell carcinoma: multiphase MDCT enhancement patterns and morphologic features. Am J Roentgenol. 2013;201(6):1268–1276.

https://doi.org/10.2214/AJR.13.10813 DOI: https://doi.org/10.2214/AJR.13.10813

Vasudev NS, Wilson M, Stewart GD, et al. Challenges of early renal cancer detection: symptom patterns and incidental diagnosis rate in a multicentre prospec-tive UK cohort of patients presenting with suspected renal cancer. BMJ Open. 2020;10(5):e035938.

https://doi.org/10.1136/bmjopen-2019-035938 DOI: https://doi.org/10.1136/bmjopen-2019-035938

Rosenblad AK, Sundqvist P, Harmenberg U, et al. Surgical waiting times and all-cause mortality in patients with non-metastatic renal cell carcinoma. Scand J Urol. 2022;56(5–6):383–390.

https://doi.org/10.1080/21681805.2022.2107067 DOI: https://doi.org/10.1080/21681805.2022.2107067

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Published

2024-01-16

How to Cite

Galtung, K. F., Lauritzen, P. M., Sandbæk, G., Bay, D., Ponzi, E., Baco, E., … Rud, E. (2024). Computed tomography for visible haematuria – a single nephrographic phase is sufficient for detecting renal cell carcinoma. Scandinavian Journal of Urology, 59, 10–18. https://doi.org/10.2340/sju.v59.18467

Issue

Vol. 59 (2024)

Section

Original research article

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Copyright (c) 2024 Kristina Flor Galtung, Peter Mæhre Lauritzen, Gunnar Sandbæk, Dag Bay, Erica Ponzi, Eduard Baco, Nigel Christopher Cowan, Anca Mihaela Naas, Erik Rud

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work. 

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