Home 
Reports Health and Medicine Content
next article
10.01.2013
Microscopic amounts of blood in urine have been considered a risk factor for urinary tract malignant tumors. However, only a small proportion of patients referred for investigation are subsequently found to have cancer.
A new Kaiser Permanente Southern California study published in the February Mayo Clinic Proceedings reports on the development and testing of a Hematuria Risk Index to predict cancer risk. This could potentially lead to significant reductions in the number of unnecessary evaluations.
Individuals with microscopic hematuria (three or more red blood cells per high-power field on a recent urine analysis) are currently referred for follow-up radiologic and invasive examinations, even when they are asymptomatic. American Urological Association (AUA) best practice policy recommendations include urine testing and abdominal computed tomography (CT) or intravenous pyelography plus renal ultrasonography. Patients may also undergo cystoscopy, a procedure that involves passing a narrow tube fitted with a miniature camera into the bladder to closely examine both the bladder and urethra.
In an earlier study, researchers had found that the AUA practice recommendations did not perform well in identifying which patients were most likely to have malignant tumors, suggesting that there might be alternative criteria that better identify patients who truly require further evaluation. Subsequently the team of investigators conducted a prospective cohort study of patients over a two-year period in an integrated care organization in three regions along the West Coast of the United States. They identified both a test cohort and a validation cohort of patients with hematuria evaluations and followed the patients passively through their electronic health records for a diagnosis of urothelial or renal cancer. The degree of microscopic hematuria, history of gross hematuria, smoking history, age, race, imaging findings, and cystoscopy findings were evaluated as risk factors for malignant tumors.
The test cohort consisted of 2630 patients, of whom 55 (2.1%) had a neoplasm detected and 50 (1.9%) had a pathologically confirmed urinary tract cancer. The strongest predictors of cancer were age of 50 years or older and a recent diagnosis of gross hematuria. Male sex was also predictive of cancer, whereas smoking history and 25 or more red blood cells per high-power field on a recent urinalysis were not statistically significant.
The findings were used to create a Hematuria Risk Index to predict cancer risk and performed comparably in the validation cohort of 1784 patients. Overall, 32% of the population was identified as low risk and 0.2% had a cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer found.
"These data confirm that a large number of follow-up examinations could be safely avoided," observes senior investigator Steven J. Jacobsen, MD, PhD, Kaiser Permanente Southern California, Pasadena, California. "They suggest that microscopic hematuria is an unreliable indicator of urinary tract malignant tumors. Patients with microscopic hematuria younger than 50 years and with no history of gross hematuria may not benefit from further evaluation and therefore could avoid unnecessary risk from radiation exposure and invasive endoscopy. These findings may be used to simplify referral guidelines for evaluation in asymptomatic patients with microscopic hematuria and reduce the number of unnecessary evaluations."
Rachael Zaleski | Source: EurekAlert!
Further information: www.elsevier.com
next article
Overview of the latest five Focus news of the innovations-report:
In the focus: Laser Polishing Accelerates Surface Finish of Dental and Blood-carrying Implants
On 28 November 2012, the partners of the project ?MediSurf?, funded by the German Federal Ministry of Economics and Technology, presented their research results in Aachen, Germany.
Led by the Fraunhofer Institute for Laser Technology ILT, a consort of seven project partners addressed the task of reducing the time needed to process dental and blood-carrying implants while maintaining their high bio- and haemocompatibility. To accomplish this, a flexible and cost-effective plant, among others, was developed to automatically ...
In the focus: How the brain stays receptive: researchers examine the role of channel protein in learning
PLoS ONE: Pannexin1 is critical for memory and orientation
The channel protein Pannexin1 keeps nerve cells flexible and thus the brain receptive for new knowledge. Together with colleagues from Canada and the U.S., researchers at the Ruhr-Universit?t Bochum led by the junior professor Dr. Nora Prochnow from the Department of Molecular Brain Research describe these results in PLoS ONE. ...
In the focus: Bugs need symbiotic bacteria to exploit plant seeds
While common firebugs have no impact on humans, their relatives, the cotton stainers, are serious agricultural pests. Researchers at the Max Planck Institute for Chemical Ecology in Jena, Germany, recently discovered that these bugs need bacterial symbionts to survive on cotton seeds as their sole food source.
Removal of the symbionts or reciprocal exchange of bacteria between firebugs and cotton stainers led to high mortality and low mating success, demonstrating the importance of the bacterial helpers for growth and reproduction. Thus, symbiotic bacteria constitute a key factor not only for the ecological success of firebugs but also ...
In the focus: New path to more efficient organic solar cells uncovered at Berkeley Lab's advanced light source
Why are efficient and affordable solar cells so highly coveted? Volume. The amount of solar energy lighting up Earth's land mass every year is nearly 3,000 times the total amount of annual human energy use.
But to compete with energy from fossil fuels, photovoltaic devices must convert sunlight to electricity with a certain measure of efficiency. For polymer-based organic photovoltaic cells, which are far less expensive to manufacture than silicon-based solar cells, scientists have long believed that the key to high efficiencies rests in the ...
In the focus: Molecular 'Two-Way Radio' Directs Nerve Cell Branching And Connectivity
Insect research yields insights for muscle control and nerve disorders in mammals, including humans
Working with fruit flies, Johns Hopkins scientists have decoded the activity of protein signals that let certain nerve cells know when and where to branch so that they reach and connect to their correct muscle targets.
The proteins? mammalian counterparts are known to have signaling roles in immunity, nervous system ...
pulitzer prize winners nfl 2012 schedule gmail down tim lincecum ryan oneal file taxes online tupac shakur
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.