The Impact of Ureteroscopy following Computerized Tomography Urography in the Management of Upper Tract Urothelial Carcinoma
Por:
Gallioli, A, Territo, A, Mercade, A, Fontana, M, Boissier, R, Gaya, JM, Emiliani, E, Sanchez-Puy, A, Martinez, MJ, Palou, J, Breda, A
Publicada:
1 feb 2021
Resumen:
Purpose: We report the reliability of computerized tomography urography and ureteroscopy in the diagnosis and management of upper tract urothelial carcinoma.
Materials and Methods: From 2015 to November 2018 we prospectively collected and retrospectively analyzed 244 cases of ureteroscopy with available preoperative computerized tomography urography. Computerized tomography urography was categorized as positive, suspicious, unlikely and negative. Correspondence between imaging, ureteroscopy and histology was analyzed. The therapeutic indication, based on 2020 EAU Guidelines and patient clinical data, was recorded before and after ureteroscopy. Cohen's Kappa was used for agreement analysis. Logistic regression was used for prediction of positive ureteroscopy.
Results: Ureteroscopy was positive for upper tract urothelial carcinoma in 107/115 (93%), 48/77 (62.3%), 15/27 (55.6%) and 12/25 (48%) cases with positive, suspicious, unlikely and negative computerized tomography urography, respectively. On cytohistology the result was confirmed in 164/182 (90.1%) cases. The positive predictive value of a filling defect, stenosis, thickening and hydronephrosis on computerized tomography urography was 87.7% (121/138 cases), 65.6% (21/32), 69.6% (64/92) and 79.7% (59/74), respectively. On multivariate analysis a filling defect (95% CI 2.76-11.5, OR 5.63, p <0.0001) or hydronephrosis (1.04-6.18, OR 2.52, p = 0.04) was associated with ureteroscopy outcome. Among cases with positive computerized tomography urography and ureteroscopy, the lesions differed in dimensions (20/107), number (14/107) and site (11/107), for a total of 45/107 (42.1%) cases. The indication of elective treatment changed after ureteroscopy in 37/76 (48.1%) cases (Kappa = 0.31), as 17/28 (60.7%), 11/20 (55%) and 11/28 (39.2%) indications were confirmed for endoscopic management, ureterectomy and nephroureterectomy, respectively.
Conclusions: The complementary use of computerized tomography urography and ureteroscopy in the diagnostic workup of upper tract urothelial carcinoma should be evaluated.
Filiaciones:
Gallioli, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Univ Milan, Dept Clin Sci & Community Hlth, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Milan, Italy
Territo, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Mercade, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Fontana, M:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Univ Milan, Dept Clin Sci & Community Hlth, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Milan, Italy
Boissier, R:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Aix Marseille Univ, La Conception Acad Hosp, APHM, Dept Urol, Marseille, France
Gaya, JM:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Emiliani, E:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Sanchez-Puy, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Martinez, MJ:
Autonomous Univ Barcelona, Dept Radiol, Fundacio Puigvert, Barcelona, Spain
Palou, J:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Breda, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
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