Alexandra Grahn1, Miden Melle-Hannah2, Camilla Malm1, Fredrik Jäderling3, Eva Radecka3, Mats Beckman3, Marianne Brehmer1,4,5. 1. Karolinska Institutet, Department of Oncology and Pathology, Stockholm, Sweden. 2. Ryhov County Hospital, Department of Urology, Jönköping, Sweden. 3. Karolinska University Hospital and Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden. 4. Department of Urology, Aarhus University Hospital, Aarhus, Denmark. 5. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Abstract
OBJECTIVE: To investigate diagnostic accuracy of multiphase computed tomography urography (MCTU) and visual assessment at ureterorenoscopy (URS) for detection of upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: Consecutive patients referred to our tertiary care centre were included in a prospective study covering the period 2005 to 2012. The patients underwent initial imaging and URS with focal samples taken. Cytopathological results served as reference standard. RESULTS: We investigated 174 renal units (RUs; renal pelvis and adjacent ureter) in 148 patients. UTUC was found in 104 RUs. MCTU had an accuracy of 0.74, sensitivity of 0.89, specificity of 0.51, positive predictive value of 0.73, and negative predictive value of 0.75; corresponding values for URS were 0.84, 0.84, 0.85, 0.89, and 0.78, respectively. MCTU had significantly higher sensitivity and accuracy compared with other imaging techniques (P<0.05). Compared with MCTU, URS had similar sensitivity but significantly greater specificity and accuracy. CONCLUSION: Both MCTU and URS are important tools in the diagnostic evaluation of UTUC although neither of those techniques achieves 100% accuracy. MCTU should be chosen as the radiographical method if there are no contraindications and URS should always be combined with focal cytology and biopsies of suspicious lesions. To enhance diagnostic precision both MCTU and URS with focal samples should be included in the diagnostic procedure. The present results add impact to current diagnostic guidelines.
OBJECTIVE: To investigate diagnostic accuracy of multiphase computed tomography urography (MCTU) and visual assessment at ureterorenoscopy (URS) for detection of upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: Consecutive patients referred to our tertiary care centre were included in a prospective study covering the period 2005 to 2012. The patients underwent initial imaging and URS with focal samples taken. Cytopathological results served as reference standard. RESULTS: We investigated 174 renal units (RUs; renal pelvis and adjacent ureter) in 148 patients. UTUC was found in 104 RUs. MCTU had an accuracy of 0.74, sensitivity of 0.89, specificity of 0.51, positive predictive value of 0.73, and negative predictive value of 0.75; corresponding values for URS were 0.84, 0.84, 0.85, 0.89, and 0.78, respectively. MCTU had significantly higher sensitivity and accuracy compared with other imaging techniques (P<0.05). Compared with MCTU, URS had similar sensitivity but significantly greater specificity and accuracy. CONCLUSION: Both MCTU and URS are important tools in the diagnostic evaluation of UTUC although neither of those techniques achieves 100% accuracy. MCTU should be chosen as the radiographical method if there are no contraindications and URS should always be combined with focal cytology and biopsies of suspicious lesions. To enhance diagnostic precision both MCTU and URS with focal samples should be included in the diagnostic procedure. The present results add impact to current diagnostic guidelines.
Authors: Joseph Brito; Borivoj Golijanin; Ohad Kott; Anna Moshnikova; Catrina Mueller-Leonhard; Boris Gershman; Oleg A Andreev; Yana K Reshetnyak; Ali Amin; Dragan Golijanin Journal: Urology Date: 2019-01-16 Impact factor: 2.649
Authors: Camilla Malm; Alexandra Grahn; Georg Jaremko; Bernhard Tribukait; Marianne Brehmer Journal: World J Urol Date: 2019-04-23 Impact factor: 4.226