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Comment & Response
December 2017

Search Images and Extrapolation Risk

Author Affiliations
  • 1West Virginia University School of Medicine, Morgantown
  • 2Carnegie Museum, Pittsburgh, Pennsylvania
JAMA Intern Med. 2017;177(12):1869-1870. doi:10.1001/jamainternmed.2017.4910

To the Editor An Original Investigation by Halpern and colleagues1 and Invited Commentary by Subak and Grady,2 both published in a recent issue of JAMA Internal Medicine, suggest that evaluation of asymptomatic microscopic hematuria may not be cost-effective. Their focus was on subsequent recognition of genitourinary cancer and would have major implications for use of the test, if that were the only implication of identification of red blood cells in urine. A recent article3 relating the lack of reliability of the dipstick method for recognizing significant hematuria may provide insight. Microscopic examination revealed significant number of red blood cells in 1 of 8 consecutively evaluated individuals (undergoing safety monitoring for medication-related toxic effects) whose dipstick testing did not reveal hematuria. That expands the pool of individuals with microscopic individuals beyond that evaluated by Halpern et al.1 That would seem to reinforce their views, except for an important detail. Workup of those individuals revealed clinically significant pathology in 20%.

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