Who needs further evaluations to diagnose upper urinary tract urothelial cancers among patients with abnormal fi ndings by enhanced CT?

doi:10.1016/j.ajur.2015.11.005

Asian Journal of Urology, 2016, 3 (1): 44-48 doi: 10.1016/j.ajur.2015.11.005

Original Article

Who needs further evaluations to diagnose upper urinary tract urothelial cancers among patients with abnormal fi ndings by enhanced CT?

Akio Takayanagi^a,b, Atsushi Takahashi^a, Fumimasa Fukuta^a,b, Manabu Okada^a,b, Masahiro Matsuki^a,b, Shunsuke Sato^a,b, Teruhisa Uehara^a,b, Shuichi Kato^a,b, Yoshio Takagi^a

a Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan;
b Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan

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Abstract Objective: We evaluated who would need further evaluations such as retrograde pyelography (RP) and/or ureteroscopy to diagnose upper urinary tract urothelial cancers (UUTUCs) when abnormal findings for the upper urinary tract (UUT) were detected by enhanced computed tomography (CT).
Methods: We retrospectively analyzed 125 patients who underwent enhanced CT for various reasons and had abnormal findings for the UUT. Patients whose tumors were suspected to be of extraureteral origin were excluded. All patients received RP and/or ureteroscopy to evaluate the UUTUCs.
Results: The median age of the 125 patients was 70 years and gross hematuria (26.4%) was the most frequently observed symptoms. RP, ureteroscopy and both were performed for 121, 59 and 55 patients, respectively. CT revealed tumor-like lesions in 58 patients and the other patients had non-tumor-like lesions. UUTUCs were found in 43 (34.4%) of the 125 patients. All of them had tumor-like lesions on CT. In 58 patients who had tumor-like lesions on CT, univariate and multivariate analyses revealed that tumor diameter and tumor enhancement were significant predictive factors for UUTUCs. ROC curve analysis of enhanced CT to diagnose UUTUCs revealed that a tumor diameter of 18 mm was the best cutoff point. The sensitivity, specificity and accuracy were 90.0%, 98.8% and 92.7% for RP and 95.5%, 100% and 97.1% for ureteroscopy, respectively. Both of them had high sensitivity, specificity and accuracy.
Conclusion: We should decide to evaluate the UUT according to the tumor diameter on enhanced CT. When we evaluate the UUT in patients with tumor diameters of less than 20 mm, ureteroscopy is recommended.

Key words： Upper urinary tract urothelial cancers Enhanced CT Ureteroscopy Retrograde pyelography

Received: 26 July 2015 Published: 29 January 2016

Corresponding Authors: Akio Takayanagi E-mail: aktakaya@sapmed.ac.jp

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	Akio Takayanagi
	Atsushi Takahashi
	Fumimasa Fukuta
	Manabu Okada
	Masahiro Matsuki
	Shunsuke Sato
	Teruhisa Uehara
	Shuichi Kato
	Yoshio Takagi

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Cite this article:

Akio Takayanagi,Atsushi Takahashi,Fumimasa Fukuta, et al. Who needs further evaluations to diagnose upper urinary tract urothelial cancers among patients with abnormal fi ndings by enhanced CT?[J]. Asian Journal of Urology, 2016, 3(1): 44-48.

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http://www.ajurology.com/EN/10.1016/j.ajur.2015.11.005 OR http://www.ajurology.com/EN/Y2016/V3/I1/44

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