Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinoma

Scolieri, Michael J.; Paik, Michael L.; Brown, Scott L.; Resnick, Martin I.

doi:10.1016/s0090-4295(00)00800-1

Cited by 118 publications

(50 citation statements)

References 10 publications

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“…Excretory urography and retrograde pyelography have been the conventional diagnostic tools used for this purpose with a CT scan reserved for further regional/nodal staging. 7 There are conflicting reports in the literature concerning the diagnostic and staging value of CT 7,8 as well as reports of its limitations 9 in accurately staging the lower stages (Ta to T2). 10 MRI is reported to have a higher positive predictive value and sensitivity than CT for diagnosis of TCC.…”

Section: Discussionmentioning

confidence: 99%

Nephroureterectomy for Transitional Cell Carcinoma – The Value of Pre-Operative Histology

Chitale

Mbakada

Irving

et al. 2008

annals

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In recent years, laparoscopic nephroureterectomy with open excision of the lower ureter is replacing this procedure as the new gold standard. [2][3][4][5][6] Whilst advances in flexible fibre-optic instruments and improvements in laser technology have made organsparing endoscopic management of low-grade TCC a realistic option in high-grade or multifocal disease, based on principles of surgical oncology, nephroureterectomy remains the preferred management option.Until fairly recently, nephroureterectomy was performed based on pre-operative imaging such as intravenous urography (IVU), CT, retrograde pyelography (RGP) and abnormal selective urine cytology. With advances in instrument technology and the regular use of flexible ureteroscopy for . Increasing use of diagnostic upper tract endoscopy has underlined the importance of obtaining a pre-operative histological diagnosis in order to avoid under-treating high-grade or multifocal disease and over-treating low-grade disease, which could, in selected cases, be managed conservatively. We review nephroureterectomy at our institution over a 10-year period with particular reference to a pre-operative histological diagnosis.

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Section: Discussionmentioning

confidence: 99%

Nephroureterectomy for Transitional Cell Carcinoma – The Value of Pre-Operative Histology

Chitale

Mbakada

Irving

et al. 2008

annals

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“…In a retrospective study by Scolieri et al [14], although only four of 13 ureteral tumors seen with IVU were detected by CT, 15 out of 16 renal pelvic lesions with a pathologic staging of T1-T2 were visualized and correctly staged by CT. CT understaged four out of five T3 lesions. The overall accuracy in predicting pathologic staging was 59.5%.…”

Section: Discussionmentioning

confidence: 94%

Improved pelvicalyceal visualization with multidetector computed tomography urography; comparison with helical computed tomography

Raptopoulos

McNamara

2005

Eur Radiol

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Our aim was to compare the quality of pelvicalyceal visualization on computed tomography (CT) urography using a small intravenous contrast material dose, hydration, and high-resolution multidetector CT (MDCT) with that of conventional helical CT. The test (MDCT) group (49 consecutive patients, 98 kidneys) was scanned 5 min following an intravenous bolus of 30 ml of iodinated contrast material. The control (helical CT) group (50 consecutive patients, 95 kidneys) was scanned 5 min following injection of 120-150 ml of intravenous contrast material. Enhancement and quality of calyceal detail were measured using a five-scale grading system (1 for no detail, 5 for cupped calyces). Calyceal attenuation was substantial in both groups (more than 220 Hounsfield units, HU) but less in the test group compared with the control group (mean 475 and 920 HU, respectively), p<0.0001. In the test group, the calyceal attenuation was less than 500 HU in the majority of cases (65/98 kidneys), while the opposite was true for the control group, where calyceal attenuation was more than 750 HU in 50/95 kidneys (p<0.001). The quality of calyceal detail was 3.4/5 in the test group compared with 1.8/5 in the control group (p<0.0001). The combination of hydration, low-contrast dose, and the high image resolution achieved with MDCT significantly improves calyceal visualization in CT urography.

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“…UTUC clinical staging is notoriously difficult and imaging has a poor predictive value except in the assessment of significant locoregional extension or the presence of metastasis according to a comprehensive review article on prognostic factors in UTUC (19). On the other hand, Scolieri et al (22) stated that because CT could not adequately distinguish Ta, T1 and T2 UTUCs, these stages were grouped together in their study. They showed that pre-operative CT was accurate for predicting pathologic TNM stage in ∼60% of UTUC patients.…”

Section: Resultsmentioning

confidence: 99%

Positive voided urine cytology predicts worse pathological findings of nephroureterectomy specimens in patients with upper tract urothelial carcinoma: does selective ureteral cytology have an additional efficacy?

Sakano

Inamoto

Inoue

et al. 2015

Jpn. J. Clin. Oncol.

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Objective: After radical nephroureterectomy, substantial numbers of patients with upper tract urothelial carcinoma are ineligible for adjuvant chemotherapy owing to diminished renal function. Accurate pre-operative prediction of worse pathological findings in radical nephroureterectomy specimens can guide appropriate patient selection for neoadjuvant chemotherapy. Herein, we evaluated pre-operative voided urine cytology and the additional efficacy of selective ureteral cytology for predicting pathological features in upper tract urothelial carcinoma patients. Methods: This retrospective cohort study comprised 722 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy. Patients with concomitant bladder cancer and those who received neoadjuvant therapy were excluded. Finally, 437 patients with urinary cytology data were enrolled in the study. We assessed the positive voided urine and selective ureteral cytology for predicting higher pathological T stage (≥pT3), higher tumor grade (3) and positive lymphovascular invasion. Results: Previous bladder cancer, tumor location, clinical T stage and voided urine cytology (P = 0.029) were independently associated with ≥pT3, whereas selective ureteral cytology was not. Gender, clinical N category and voided urine cytology (P = 0.017) were independently associated with tumor Grade 3, whereas selective ureteral cytology was not. Hydronephrosis, clinical T stage, clinical N category and voided urine cytology (P = 0.0021) were independently associated with lymphovascular invasion, whereas selective ureteral cytology was not. Conclusions: Pre-operative positive voided urine cytology was an independent predictor for worse pathological findings in radical nephroureterectomy specimens, while selective ureteral cytology had no additional efficacy. However, further studies with larger numbers of patients and complete data sets are needed to select patients for more aggressive treatments including neoadjuvant chemotherapy.

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Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinoma

Cited by 118 publications

References 10 publications

Nephroureterectomy for Transitional Cell Carcinoma – The Value of Pre-Operative Histology

Nephroureterectomy for Transitional Cell Carcinoma – The Value of Pre-Operative Histology

Improved pelvicalyceal visualization with multidetector computed tomography urography; comparison with helical computed tomography

Positive voided urine cytology predicts worse pathological findings of nephroureterectomy specimens in patients with upper tract urothelial carcinoma: does selective ureteral cytology have an additional efficacy?

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