Urologic malignancy risk is very low in women evaluated for microhematuria: Study
Atlanta, GA: A recent study in the journal Urology has reported that inappropriate referrals for microhematuria (MH) are common. Further, there is an incredibly low incidence of urologic malignancy among women evaluated for MH, but especially for those categorized as low- and intermediate-risk by new guidelines. There is a low yield of repeat evaluations for persistent, stable MH in detecting malignancy.
Microhematuria also called microscopic hematuria, refers to the presence of blood in the urine, as defined as more than 5 to 10 red blood cells per high-power field. Grace Moxley Saxona, Emory University School of Medicine, Atlanta, GA, and colleagues aimed to 1) determine the prevalence of urologic malignancy in women evaluated for microhematuria in large university-based urology practice, 2) describe clinical features shared by women with MH, and 3) evaluate a risk score for urologic malignancy in women with MH.
To work toward their objective, the researchers identified women with MH evaluated by a large, university-based urology practice between 2010 and 2020 using a retrospective chart review. Clinical and demographic variables associated with their evaluation, referral pattern, appropriateness of referral and evaluation, workup completed, and resulting diagnoses were reported.
The researchers also described patterns of repeat evaluations. Patients were stratified as low-, intermediate-, or high-risk according to AUA/SUFU recommended risk stratification.
The study revealed the following findings:
- 4456 charts resulted from an initial query based on females with ICD-9 and ICD-10 codes for MH between 2010-2020.
- 1730 patients (95.5% referrals v. 4.5% established urology patients) met criteria for inclusion in the study, and 1350 underwent evaluation for MH at the practice.
- Over 30% of referrals were considered inappropriate.
- 13 patients were diagnosed with urologic malignancy, all of whom were classified as intermediate- or high-risk according to AUA/SUFU criteria.
- Over 10% of patients had at least 2 evaluations for MH, with only 1 malignancy discovered on repeat evaluation for persistent MH.
The researchers concluded, "repeat evaluations for persistent, stable MH, appear low yield in detecting malignancy."
Reference:
The study titled, "Microhematuria in women: Prevalence of malignancy and risk score evaluation," is published in the journal Urology.
DOI: https://www.sciencedirect.com/science/article/abs/pii/S0090429521010499
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