MP33-03: Diagnostic Performance of Upper Tract Imaging Performed for Hematuria Screening: Real-World Results from a National Privately Insured Cohort

Alex Hannemann*, Simon Kim, Aurora, CO, Peter Clark, Charlotte, NC, Michael Bronsert, Aurora, CO, Boris Gershman, Boston, MA, Granville Lloyd, Rodrigo Rodrigues Pessoa, Jeffrey Morrison, Aurora, CO, Marc Smaldone, Philadelphia, PA, Eric Ballon-Landa, Aurora, CO

Introduction: Clinical practice guidelines for upper tract (UT) evaluation during hematuria evaluation were amended in 2020 to permit risk-based imaging strategies. Using a real world, privately insured, national cohort, we sought to evaluate the rates and types of UT imaging employed, as well as the diagnostic yield of each imaging modality. Consistent with prior data, we hypothesized that the rate of UT disease associated with a screening population would be low, and that the additional benefit of computed tomography (CT) over renal ultrasound (US) would be limited.

Methods: Using a national, privately insured database (MarketScan), we identified all patients with an incident diagnosis of hematuria between 2010 and 2015. Among these patients, we tabulated patient predictors and contrast-enhanced CT, US, or other imaging (non-contrast CT, MRI, retrograde pyelogram) obtained within 1 year of hematuria diagnosis. Patients receiving subsequent renal mass biopsy, renal or ureteral surgeries for the management of UT malignancy were considered to have a positive finding. Descriptive statistics and multivariable logistic regression were used to predict the likelihood of any UT findings adjusted for patient predictors.

Results: We identified 466,710 patients who underwent hematuria evaluation and received UT imaging and definitive treatment within 12 months of diagnosis. 150,880 (32.3%) received US, 296,287 (63.5%) received contrast-enhanced CT, and 19,543 (4.19%) received other imaging screening. US detected 908 UT findings among 149,972 patients (0.6%); CT detected 3,730 UT findings among 292,557 patients (1.3%); other imaging detected 636 UT findings among 18,907 patients (3.2%) (p < 0.0001). When adjusted for comorbidities, female sex (OR=1.789, 95% CI 1.687-1.897, increased age (OR=1.029, 95% CI 1.026-1.032), gross hematuria (OR=2.309, 95% CI 2.182-2.444), and CT (OR=1.822, 95% CI 1.692-1.961) or other imaging (OR=4.605, 95% CI 4.151-5.108) were associated with increased likelihood of UT finding.

Conclusions: Regardless of imaging modality, the diagnostic yield of UT imaging at the time of surveillance for hematuria is limited due to the low incidence of disease. Factors that may predispose to an UT finding include increased age, gross hematuria, female sex, and CT or other imaging. As supported by updated clinical practice guidelines, clinicians should pursue risk-based strategy for UT imaging at the time of hematuria evaluation, although these data may suggest increased utilization of US at the initial evaluation.

Source of Funding: Schramm Foundation