Multiphasic multidetector-row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract

Fritz, G. A.; Schoellnast, Helmut; Deutschmann, Hannes; Quehenberger, Franz; Tillich, Manfred

doi:10.1007/s00330-005-0078-0

Cited by 117 publications

(56 citation statements)

References 18 publications

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“…In general, opinions are divided on the accuracy of CT scans for the diagnosis of invasion of UTUC. Fritz et al reported that multiphasic multidetector-row CT, with its high spatial and temporal resolution, can accurately detect TCC of the upper urinary tract, with 87.8% accuracy in predicting its stage (23). In contrast, Gandrup et al demonstrated that a split-bolus CTU cannot distinguish between invasive and non-invasive urothelial tumors in the upper tract (24).…”

Section: Discussionmentioning

confidence: 99%

Systematic regional lymph node dissection for upper tract urothelial carcinoma improves patient survival

Furuse

Matsushita

Yajima

et al. 2016

Japanese Journal of Clinical Oncology

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Objective: Unlike for bladder cancer, the impact of regional lymph node dissection for upper tract urothelial carcinoma is unclear. We explored whether patient survival was influenced by systematic regional lymph node dissection, using resection templates according to the main tumor location, during radical nephroureterectomy for upper tract urothelial carcinoma. Methods: The systematic regional lymph node dissection group was defined as cases in which the dissection of nodes and surrounding tissues followed the established template, and the nonsystematic regional lymph node dissection group as cases undergoing limited or no lymph node dissection. We performed radical nephroureterectomy on 98 consecutive patients with various stages of upper tract urothelial carcinoma from May 1994 to September 2014 at our institution. Of these, 77 patients with cTanyN0M0 of upper tract urothelial carcinoma undergoing radical nephroureterectomy were grouped into systematic regional lymph node dissection or non-systematic regional lymph node dissection cohorts according to the extent of dissection, and their outcomes compared. Results: Forty-four patients were categorized as systematic regional lymph node dissection and 33 as non-systematic regional lymph node dissection, including 17 with more limited nodal dissection and 16 with no nodal dissection. Five-year recurrence-free survival and cancer-specific survival were significantly higher in the systematic regional lymph node dissection (93% and 94%, respectively) than in the non-systematic regional lymph node dissection group (75% and 77% recurrence-free survival and cancer-specific survival, respectively). Further, 5-year recurrence-free survival and cancer-specific survival of muscle-invasive upper tract urothelial carcinoma (pT2-4) were significantly higher in the systematic regional lymph node dissection (87% and 91%, respectively) than in the non-systematic regional lymph node dissection group (59% and 62%, respectively) (P = 0.0237 and P = 0.0224). Neither recurrence-free survival nor cancer-specific survival was significantly prolonged by systematic dissection in patients with pTis-1 histology. Conclusions: Systematic regional lymph node dissection during radical nephroureterectomy for cTanyN0M0 upper tract urothelial carcinoma patients has a significantly beneficial impact on survival compared with patients undergoing more limited dissection, especially in the cases involving muscle invasion.

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Section: Discussionmentioning

confidence: 99%

Systematic regional lymph node dissection for upper tract urothelial carcinoma improves patient survival

Furuse

Matsushita

Yajima

et al. 2016

Japanese Journal of Clinical Oncology

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“…Attempts to detect direct transmural tumor extension on multidetector Chi square analysis P = 0.9334 abdominal/pelvic CT (MDCT) scans by examining ureteral wall thickness, loss of renal sinus fat, or abnormal adjacent fat parenchyma are unreliable in clinical practice. In a study conducted by Fritz and associates, 9 MDCT correctly identified only 4/6 (66%) of pT 3 renal pelvis UTUC. In examining overall accuracy in tumor stage prediction, the study quoted 87.8% (36/41), with a sensitivity of only 66.6% (8/12) for detection of invasion of UTUC into adjacent tissues.…”

Section: Discussionmentioning

confidence: 96%

The Significance of Functional Renal Obstruction in Predicting Pathologic Stage of Upper Tract Urothelial Carcinoma

Amirian

Radadia

Narins

et al. 2014

Journal of Endourology

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Background and Purpose: Assessing the severity of upper tract urothelial carcinoma (UTUC) has been difficult because of inadequate biopsy specimens. Additional predictive parameters of disease stage would be useful when deciding a treatment plan; it has been suggested that preoperative hydronephrosis can be a surrogate. We examined the relationship between preoperative ipsilateral renal obstruction identified by imaging with final pathologic stage after nephroureterectomy (NU) for UTUC. We then analyzed those patients with ipsilateral renal obstruction and examined if tumor location is associated with an advanced pathologic stage. Methods: Patients who underwent NU for UTUC between the years 2001 to 2013 were analyzed and relevant staging studies and pathology were reviewed. Criteria for ipsilateral renal obstruction were defined by the presence of a delayed nephrogram on CT scan, renal cortical atrophy with associated hydronephrosis on crosssectional imaging, and/or >10% split function discrepancy on nuclear renal scintigraphy with associated hydronephrosis. Results: Eighty-two patients met inclusion criteria; 26/82 (31.7%) had locally advanced disease (pT 3 /T 4 ), while 56/82 (63.4%) had organ-confined ( £ pT 2 ) disease. Of the patients with pT 3 /T 4 disease, 10/26 (38.5%) demonstrated radiographic evidence of functional obstruction of the ipsilateral renal unit; similarly, in patients with £ pT 2 disease, 21/56 (37.5%) demonstrated ipsilateral renal obstruction (P = 0.93). Of the patients with ipsilateral renal obstruction, in those patients with pT 3 /T 4 disease, 7/10 (70.0%) had ureteral tumor involvement while 9/21 (42.9%) patients with £ pT 2 disease had tumor in the ureter (P = 0.25). Conclusions: This study suggests that renal obstruction by radiographic analysis does not always predict advanced stage. In addition, there is a trend toward advanced stage when a patient has radiographic evidence of ipsilateral renal dysfunction and a ureteral tumor.

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“…Az egyre növekvő, ám még csak kísér-leti jelleggel alkalmazott eljárások a biopsziás mintavétel diagnosztikus korlátozottságának javítását célozzák. Ezek közül az optikai koherencia-tomográfia, az endoluminalis ultrahangvizsgálat, a konfokális lézer endomikroszkópia, a multipa ramet rikus MRI, a 11C kolin PET/CT és a nagy felbontású ure tero endoszkópia emelhető ki (16)(17)(18)(19)(20). A két tumortípus diagnosztikus lépései kis különbségektől eltekintve megegyeznek.…”

Section: Diagnosztikai Módszerekunclassified

A felső húgyúti urothel sejtes tumorok kezelése-hasonlóságok és különbségek a húgyhólyag urothelialis tumoraival

Kubik¹,

Szarvas²,

Módos³

et al. 2017

Magyar Urológia

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ÖSSZEFOGLALÁSA felső húgyúti urothel sejtes tumorokat (FeHUT) valamint az alsó húgyúti urothel sejtes tumorokat (AHUT) számos klinikai és patológiai hasonlóságuk alapján sokáig ugyanazon tumorentitás különbözö lokalizációjaként tartották számon. Az elmúlt évek kutatásai azonban egyre több, a két tumor különbözőségét feltáró eredményt szolgáltattak. A jelen összefoglaló tanulmány célja, hogy a FeHUT vizsgálata során nyert kutatási eredményeket ismertetve, rámutasson a két tumortípus közötti epidemiológiai, etioló -giai, stádium-és rizikómeghatározási, illetve a sebészi és más onkológiai kezelést érintő hasonlóságokra és különbségekre. Az AHUT és FeHUT közös rizikótényezői közé tartozik a dohány-zás és az aromás amin-vegyületek, míg az arisztolochia-savval történő érintkezés és a tumoros anamnézisben a familiáris Lynchszindróma jelenléte főleg a FeHUT jellemzője. A két tumortípus differenciáltsági szintjének meghatározása megegyezik, azonban stádiumbesorolásuk a különböző anatómiai elhelyezkedésből fakadóan kissé különbözik. Mindkét esetben az elsődleges terápiás lépés a műtéti ellátás. A FeHUT pontatlan preoperatív stádium -be so rolása miatt azonban a nephroureterectomia utólag számos esetben feleslegesnek bizonyult. A preoperatív patológiai stá -diumbesorolás bizonytalansága, a kórjóslat megbízhatóságának javításával korrigálható lenne, amely a vesemegtartó műtétek számának növekedéséhez, ezáltal a betegek sebészi túlkezelésé-nek csökkenéséhez vezetne. Számos vizsgálat igazolta, hogy a szövettani minták molekuláris vizsgálatát a képalkotó vizsgála-tokkal együtt értékelő, prediktív modellek jelentős mértékben javítani tudják a kórjóslat minőségét. Bár az eltávolított nyirokcsomók pozitív terápiás értéke hasonló a két tumortípusnál, a FeHUT esetén végzett nyirokcsomó-eltávolításra jelenleg nincs egyértel-mű ajánlás és a nyirokcsomók eltávolításának optimális menete, illetve megfelelő mennyisége sem meghatározott. A szisztémás neoadjuváns és adjuváns kemoterápia alkalmazása túlélési előnyt jelenthet a FeHUT kezelése során, amelynek igazolására azonban további prospektív tanulmányok szükségesek.

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Multiphasic multidetector-row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract

Cited by 117 publications

References 18 publications

Systematic regional lymph node dissection for upper tract urothelial carcinoma improves patient survival

Systematic regional lymph node dissection for upper tract urothelial carcinoma improves patient survival

The Significance of Functional Renal Obstruction in Predicting Pathologic Stage of Upper Tract Urothelial Carcinoma

A felső húgyúti urothel sejtes tumorok kezelése-hasonlóságok és különbségek a húgyhólyag urothelialis tumoraival

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