Although little controversy exists regarding the indication for urologic evaluation for patients with gross hematuria, the evaluation of patients with the much more common finding of microscopic hematuria is complicated by a lack of clarity regarding indications for clinical referral, according to a review of current clinical practice by the American College of Physicians’ High Value Care Task Force by Nielsen et al published in Annals of Internal Medicine. The Task Force findings highlight opportunities to increase awareness and define a high-value strategy to evaluate hematuria as a sign of urinary tract cancer.
Study Methodology and Findings
The study authors conducted a narrative literature review of published clinical guidelines that addressed the evaluation of hematuria as a marker of occult urinary tract cancer and other relevant studies from peer-reviewed literature.
To avoid unnecessary, invasive, and expensive testing and procedures in patients with hematuria, the American College of Physicians offers the following advice to clinicians for high-value care on the evaluation of hematuria as a marker of occult urinary tract cancer:
“Further research is needed to strengthen the evidence base supporting a high-value approach to the common finding of AMH [asymptomatic microscopic hematuria],” concluded the study’s authors.
Amir Qaseem, MD, PhD, MHA, of the American College of Physicians, is the corresponding author of this article in the Annals of Internal Medicine.
Matthew Nielsen, MD, MS, reported personal fees from the American College of Physicians during the conduct of this study, other fees from Grand Rounds and Urology Care Foundation/Astellas outside the submitted work, and grants from the American Cancer Society and the National Institute of Health outside the submitted work. The other authors reported no potential conflicts of interest.
Funding for this study was provided by the American College of Physicians.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.