New classification of hydronephrosis on 18F-FDG-PET/CT predicts post-operative renal function and muscle-invasive disease in patients with upper urinary tract urothelial carcinoma

Asai, Satoshi; Fukumoto, Takumi; Watanabe, Ryuta; Koyama, Kanae; Sawada, Yuichiro; Noda, Takehiro; Miura, Noriyoshi; Yanagihara, Yoshio; Miyauchi, Yuhei; Miyagawa, Masao; Kikugawa, Tadahiko; Sakaguchi, Takashi

doi:10.1093/jjco/hyy135

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…It seems better to restrict the study cohort to only patients with ureteral carcinoma for analyzing tumor-induced hydronephrosis, because hydronephrosis could not be accurately evaluated and graded in patients with renal pelvic carcinoma. Asai et al proposed a unique classification of hydronephrosis based on the renal excretion of 18F-flurodeoxyglucose (FDG) on FDG-positron emission tomography/CT [15]. Their results showed that hydronephrosis without FDG excretion, defined as "type 2 hydronephrosis," was associated with less decline in renal function after RNU and a higher risk of muscle-invasive disease (≥pT2).…”

Section: Discussionmentioning

confidence: 99%

Down-Grading of Ipsilateral Hydronephrosis by Neoadjuvant Chemotherapy Correlates with Favorable Oncological Outcomes in Patients Undergoing Radical Nephroureterectomy for Ureteral Carcinoma

et al. 2019

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Few studies have analyzed the details of neoadjuvant chemotherapy (NAC)-induced changes in patients with upper tract urothelial carcinoma. This study aimed to describe the impact of down-grading ipsilateral hydronephrosis by NAC for ureteral carcinoma. An observational study was conducted in 32 patients with cT1-3N0M0 ureteral carcinoma treated with NAC and radical nephroureterectomy. Hydronephrosis was classified into five grades based on computed tomography findings. We focused on the differences between the baseline and post-NAC status of ipsilateral hydronephrosis, radiographic tumor response, and blood markers. Down-grading, no change, and up-grading was observed in 10 (31%), 21 (66%), and 1 (3%) patients, respectively. In univariate analysis, locally advanced disease (cT3), severe hydronephrosis (grade 3/4) at baseline, no change/up-grading of hydronephrosis after NAC, and pathological lymphovascular involvement were identified as potential prognostic factors of progression-free and cancer-specific survival after radical nephroureterectomy. Locally advanced disease (cT3) at baseline and no change/up-grading of hydronephrosis by NAC were independently associated with poor progression-free survival. Notably, none of the patients with NAC-induced down-grading of hydronephrosis died of ureteral carcinoma during the follow-up. We reported the prognostic impact of down-grading of ipsilateral hydronephrosis, which could serve as a useful aid or clinical marker for decision-making.

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Section: Discussionmentioning

confidence: 99%

Down-Grading of Ipsilateral Hydronephrosis by Neoadjuvant Chemotherapy Correlates with Favorable Oncological Outcomes in Patients Undergoing Radical Nephroureterectomy for Ureteral Carcinoma

et al. 2019

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“…It was reported that malignant tumors were frequently presented as hypermetabolic lesions in 18F-FDG-PET/CT due to high invasiveness and growth activity. Therefore, 18F-FDG-PET/CT could be used to diagnose UTUC and predict the presence of muscularis invasion or lymph node metastasis ( 39 , 40 ), which might help guide perioperative treatment decisions (for example, intraoperative lymph node dissection or chemotherapy) ( 6 ). Previous studies have reported that the combination of NLR with other tools could be used to help make clinical decision ( 35 , 41 ).…”

Section: Discussionmentioning

confidence: 99%

“…At the early stages of tumor development, there was no significant difference in the impact on UUT obstruction between benign and malignant lesions. However, preoperative hydronephrosis frequently indicates a high probability of muscle infiltration of UTUC for muscle layer invasion could cause more severe intraluminal obstruction ( 6 , 42 , 43 ). This study demonstrated that the combination of NLR and 18F-FDG-PET/CT was an independent predictor of malignant lesions of UUT.…”

Section: Discussionmentioning

confidence: 99%

“…The final pathological diagnosis was confirmed by surgical specimens. The TNM staging system formulated by the American Joint Committee on Cancer-Union International contre le Cancer was used for tumor staging ( 6 ).…”

Section: Methodsmentioning

confidence: 99%

“…Two nuclear medicine physicians independently interpreted the imaging of 18F-FDG-PET/CT with a diagnostic consistency of 97.0%. Disagreement was resolved by the consultation of these two nuclear medicine physicians ( 6 , 29 ).…”

Section: Methodsmentioning

confidence: 99%

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Role of 18F-FDG-PET/CT in Combination With Neutrophil–Lymphocyte Ratio in the Diagnosis of Upper Urinary Tract Lesion: Can We Accurately Predict Malignant Tumor?

Lin

Chen

et al. 2021

Front. Oncol.

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ObjectiveTo explore whether preoperative 18Fluorine-Fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) in combination with neutrophil–lymphocyte ratio (NLR) could accurately predict malignant lesions of upper urinary tract (UUT).Methods and MaterialsThe clinicopathologic data of a total of 252 patients with UUT lesions receiving surgical treatment at our center from January 2012 to November 2019 were retrospectively analyzed. All patients performed routine preoperative hematological examination, urine cytology, computed tomography urography (CTU), and 18F-FDG-PET/CT. Clinicopathologic data between 179 cases with malignancy (Group 1) and 73 cases with benign lesions (Group 2) were compared. Multivariate logistic regression analysis was used to explore the independent predictors of malignant UUT lesions. Receiver operating characteristic (ROC) curve was used to evaluate the predictive ability.ResultsAmong all patients, univariate analysis showed that NLR, hydronephrosis, CTU indicating malignancy, and PET/CT indicating malignancy were significantly associated with malignant UUT lesions; multivariate analysis revealed that NLR, CTU indicating malignancy, and PET/CT indicating malignancy were independent predictors of malignant UUT lesions; the area under ROC curve (AUC) of NLR, CTU, PET/CT, combining CTU and NLR, combining PET/CT and NLR, and combining PET/CT and CTU were 0.735, 0.788, 0.857, 0.863, 0.913, and 0.919, respectively, for postoperative pathological malignancy. Among 68 patients undergoing ureteroscopy biopsy, univariate analysis suggested that NLR, positive urine exfoliation cytology, CTU indicating malignancy, and PET/CT indicating malignancy were significantly associated with malignant UUT lesions; multivariate analysis demonstrated that positive urine cytology, PET/CT indicating malignancy, and NLR were independent predictors of malignant UUT lesions; the AUC of NLR, ureteroscopy biopsy, and combining PET/CT and NLR were 0.768, 0.853, and 0.839, respectively, for postoperative pathological malignancy.ConclusionsCombining preoperative NLR and PET/CT performed well in differentiating benign from malignant UUT lesions, which could not be identified by traditional imaging or urine cytology. Combining preoperative NLR and PET/CT could be used to reduce unnecessary ureteroscopy biopsy, which might result in tumor cell dissemination and risk of associated complications.

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Reins, uretères, vessie

Sbihi¹

2022

TEP-TDM en Pratique

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New classification of hydronephrosis on 18F-FDG-PET/CT predicts post-operative renal function and muscle-invasive disease in patients with upper urinary tract urothelial carcinoma

Cited by 9 publications

References 24 publications

Down-Grading of Ipsilateral Hydronephrosis by Neoadjuvant Chemotherapy Correlates with Favorable Oncological Outcomes in Patients Undergoing Radical Nephroureterectomy for Ureteral Carcinoma

Down-Grading of Ipsilateral Hydronephrosis by Neoadjuvant Chemotherapy Correlates with Favorable Oncological Outcomes in Patients Undergoing Radical Nephroureterectomy for Ureteral Carcinoma

Role of 18F-FDG-PET/CT in Combination With Neutrophil–Lymphocyte Ratio in the Diagnosis of Upper Urinary Tract Lesion: Can We Accurately Predict Malignant Tumor?

Reins, uretères, vessie

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