The American College of Physicians issued high-value care advice this week on evaluating hematuria as a marker of occult urinary tract cancer.
Because hematuria is a common finding in ambulatory care, and patients often undergo routine urine dipstick testing and microscopic examinations despite absence of recommendations, ACP's High Value Care Task Force performed a narrative review of the available evidence to help inform clinical practice. The task force's goal was to describe indications for evaluation of hematuria as a marker of occult urinary tract cancer and offer advice to help clinicians make high-value decisions about referral for urologic assessment.
The Task Force's advice is as follows:
- 1. Clinicians should include gross hematuria in their routine review of systems and specifically ask all patients with microscopic hematuria about any history of gross hematuria.
- 2. Clinicians should not use screening urinalysis for cancer detection in asymptomatic adults.
- 3. Clinicians should confirm hemepositive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults.
- 4. Clinicians should refer for further urologic evaluation all adults with gross hematuria, even if self-limited.
- 5. Clinicians should consider urology referral for cystoscopy and imaging in adults with microscopically confirmed hematuria in the absence of some demonstrable benign cause.
- 6. Clinicians should pursue evaluation of hematuria even if the patient is receiving antiplatelet or anticoagulant therapy.
- 7. Clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection in the initial evaluation of hematuria.
The high-value care advice was published Jan. 26 by Annals of Internal Medicine. The full paper is available free of charge online.