title: Computed tomography of primary transitional cell carcinoma of upper urinary tracts.
abstract: Preoperative computed tomography (CT) was utilized to evaluate 20 patients with primary transitional cell carcinoma of the upper urinary tracts. Of the 20 patients, 18 (90%) had CT visualization of the tumor as either a discrete mass or local ureteral and/or renal pelvic wall thickening; 2 (10%) had false-negative examinations. Seven of the 20 patients (35%) had CT evidence of tumor extension demonstrated by frank tumor invasion beyond the urothelium or by perirenal pelvic and/or periureteral fat streaks. Of the 4 patients with fat streaks, 2 (50%) had superficial tumors (T(A)T2), 1 had a T1 (25%) tumor, and 1 had a T3 (25%) tumor. All 3 patients with CT findings of direct extension of tumor through the wall of the ureter or renal pelvis had T3 tumors. Among the 13 with localized noninvasive tumor on CT, 5 (38%) had superficial tumors (TA, TIS, T1), 5 (38%) had T2 tumors, and 3 (21%) had T3 tumors. Of the 5 patients with enlarged regional lymph nodes (greater than or equal to 1.5 cm) on CT, 2 had tumor confirmed histologically, 2 had subsequent negative CT-guided biopsies, and 1 had a negative lymphadenectomy. Distant metastasis was discovered in 1 patient. The data suggest that when CT demonstrates direct tumor extension through the renal pelvic or ureteral wall, it is a sensitive indicator of high-stage disease. However, in the absence of this finding, CT is of limited value in staging patients with primary transitional cell carcinoma of the pyeloureteral system.
authors.affiliation: Department of Surgery, Ohio State University, Columbus.
authors.forename: R A
authors.initials: RA
authors.lastname: Badalament
authors.forename: W F
authors.initials: WF
authors.lastname: Bennett
authors.forename: J G
authors.initials: JG
authors.lastname: Bova
authors.forename: P R
authors.initials: PR
authors.lastname: Kenworthy
authors.forename: H A
authors.initials: HA
authors.lastname: Wise
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Perez
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging*; D007682:Kidney Pelvis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014516:Ureteral Neoplasms / Q000000981:diagnostic imaging*; D014567:Urography