High-frequency endoluminal ultrasonography as an aid to the staging of upper tract urothelial carcinoma: imaging findings and pathologic correlation.
OBJECTIVE
We analyzed endoluminal ultrasonography (ELUS) for evaluating renal pelvic and ureteral, or upper tract, urothelial carcinoma (UTUC).


METHODS
Patients being treated for suspected UTUC underwent ureteroscopic evaluation immediately before ELUS, followed by ureteroscopic biopsy. Endoluminal ultrasonography was performed using mechanical radial scanning at 30 MHz in the B-mode using a 1.7-mm-diameter (5F) probe, which allows placement over a guide wire. Where possible, ELUS findings at the time of endoscopy were compared to the pathologic findings of resected specimens.


RESULTS
From July 2008 to March 2009, 15 patients underwent ELUS during ureteroscopic evaluation of suspected UTUC. No complications occurred as a result of ELUS. Ultrasonographic and endoscopic imaging findings from the evaluation of normal and abnormal anatomy were shown. Eleven patients had evaluable data. Seven patients underwent initial nephroureterectomy. Six of the 7 patients had accurate ELUS staging when correlated with the pathologic findings. The positive predictive value of ELUS was 66.7%, and the negative predictive value was 100%.


CONCLUSIONS
In this study, we showed the potential role of ELUS in improving the clinical staging accuracy of UTUC. Although the number of patients was too small to allow for definitive conclusions, these promising initial data suggest that, with additional experience, this modality can substantially improve the risk stratification of patients with UTUC.
Matin
Surena F
SF
Department of Urology, University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA. surmatin@mdanderson.org
Kamat
Ashish M
AM
Grossman
H Barton
HB
D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D019160:Endosonography; D006801:Humans; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D018666:Ureteroscopy; D014571:Urologic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery