RT Journal Article
SR Electronic
T1 The diagnostic value of macroscopic haematuria for the diagnosis of urological cancer in general practice.
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP 31
OP 35
VO 53
IS 486
A1 Rudi Bruyninckx
A1 Frank Buntinx
A1 Bert Aertgeerts
A1 Viviane Van Casteren
YR 2003
UL http://bjgp.org/content/53/486/31.abstract
AB BACKGROUND: The diagnostic value and the impact of some signs and symptoms in most diseases in primary care have only been studied incompletely. AIM: To assess the diagnostic value of macroscopic haematuria for the idagnosis of urological cancer (bladder, kidney) in a general practice setting, as well the influence of age, sex, and some additional signs and symptoms. DESIGN OF STUDY: Diagnostic study. SETTING: The study was performed in a sentinel station network of general practices in Belgium, covering almost 1% of the population. SUBJECTS: All patients attending their general practitioner and complaining of haematuria during 1993 and 1994 were included for the prospective part of the study. Every patient diagnosed with a urological cancer in this period was registered for the retrospective part. METHOD: Mean outcome measures of sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio were used to assess diagnostic value. RESULTS: Within the registration year 1993-1994, patient-doctor encounters, related to 83,890 patient-years, were registered. The positive predictive value (PPV) for urological cancer was 10.3% (95% CI = 7.6% to 13.7%). Sensitivity was 59.5% (95% CI = 50.4% to 60.1%). The PPV of patients aged over 60 years was 22.1% (95% CI = 15.8% to 30.1%) for men and 8.3% (95% CI = 3.4% to 17.9%) for women. In the age group 40 to 59 years, the PPV was 3.6% (95% CI = 0.6% to 13.4%) for men and 6.4% (95% CI = 1.7% to 18.6%) for women. In the prospective part of the study, no urological cancer was found in the age group under 40 years. CONCLUSION: Men older than 60 years of age with macroscopic haematuria have a high positive predictive value for urological cancer. In these patients, a thorough investigation is indicated. In patients over 40 years of age of either sex, referral or watchful waiting can be justified.