title: Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract.
abstract: BACKGROUND
  Transitional cell carcinoma of the upper urinary tract (UUT-TCC) accounts for 5% to 10% of all renal tumours and 5% to 6% of all urothelial tumours all over the world. In China, the proportion of UUT-TCC to all urothelial tumours may be 26%, which is higher than that in the western world. The early diagnosis of UUT-TCC is difficult and the present study elucidates the diagnostic value of poor or nonvisualization (PNV) in intravenous urography in patients with UUT-TCC and its correlations with pathological findings and clinical characteristics.
  
  
  METHODS
  The data of 172 consecutive patients between January 1997 and January 2005 with UUT-TCC who underwent nephroureterectomy in our departments were selected and analyzed retrospectively.
  
  
  RESULTS
  Of our sample, 144 cases presented with gross haematuria (83.7%) and 12 with microscopic haematuria (7.0%). Forty-six cases (26.7%) were detectable by cytology. Filling defect identified 36 positive cases of 172 patients (20.9%), PNV was present in the images of 105 of 172 patients (61.0%). The detection rate by PNV (61.0%) was significantly different from that by cytology (26.7%) or by filling defect (20.9%) (P = 0.031, P = 0.001, respectively). Univariate logistic regression analysis for PNV showed that tumour stage, grade and size were significant predictors (P = 0.028; P = 0.031; P = 0.006, respectively). Tumour stage and size were identified as independent risk factors in the multivariate logistic regression model (P = 0.042; P = 0.014).
  
  
  CONCLUSIONS
  Except for suspected urolithiasis, urinary tuberculosis or congenital abnormalities, UUT-TCC should be considered if PNV exists in intravenous urography especially of old patients. The value of PNV is much more significant than filling defect in intravenous urography in the diagnosis of UUT-TCC. It is supposed that PNV carries more risk of higher stage and larger tumour size in UTT-TCC.
authors.affiliation: Department of Urology, Ruijin Hospital, College of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China. shenzhj@mail.hz.zj.cn
authors.forename: Zhou-jun
authors.initials: ZJ
authors.lastname: Shen
authors.forename: Liao-yuan
authors.initials: LY
authors.lastname: Li
authors.forename: Guo-dong
authors.initials: GD
authors.lastname: Liao
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012680:Sensitivity and Specificity; D014571:Urologic Neoplasms / Q000000981:diagnostic imaging*