Chicago, IL: A nomogram can accurately predict the bladder cancer risk during the evaluation of microscopic hematuria (MH), a recent study in the journal Urologic Oncology has suggested. This can potentially be used to safely avoid cystoscopy and genitourinary imaging in those at the lowest risk of bladder cancer.
In simpler words, a nomogram can accurately discriminate between patients with microscopic hematuria who will and will not be diagnosed during an evaluation for bladder cancer.
A majority of patients who undergo a diagnostic evaluation for MH do not have bladder cancer. Identifying MH patients with a high risk of harbouring bladder cancer can allow for a risk-adjusted approach to diagnostic interventions with the goal of safely reducing unnecessary evaluations.
Richard S. Matulewicz, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, and colleagues conducted this study to identify objective clinical factors associated with a bladder cancer diagnosis and to use these factors to create a nomogram that accurately predicts risk of bladder cancer.
For the purpose, the researchers retrospectively identified 4,178 patients with a new diagnosis of microhematuria during an 8.5 year period. All patients who had a complete MH evaluation were randomized to a training or a validation cohort. Receiver operating curves to identify bladder cancer were constructed for the training and validation cohort and tested for their ability to discriminate true cases. A nomogram to predict a bladder cancer diagnosis was created.
Key findings of the study include:
In 4,178 patients split into training and validation cohorts, those diagnosed with bladder cancer were shown to be older, have a greater degree of MH (more RBC/hpf), and were former or current smokers.
A nomogram created using this the model was able to predict the risk of a bladder cancer diagnosis with good discrimination (areas under the curve 0.79).
A cutoff of 0.01 probability demonstrated a sensitivity of 99.1% and a negative predictive value of 99.7%.
"A nomogram can accurately predict the risk of bladder cancer diagnosed during the evaluation of MH and can potentially be used to avoid a significant number of workups in those at the lowest risk" concluded the authors.
The study, "A simplified nomogram to assess risk of bladder cancer in patients with a new diagnosis of microscopic hematuria," is published in the journal Urologic Oncology.
DOI: https://doi.org/10.1016/j.urolonc.2019.12.010