Diagnostic accuracy of computed tomography urography and visual assessment during ureterorenoscopy in upper tract urothelial carcinoma.
OBJECTIVE
To investigate diagnostic accuracy of multiphase computed tomography urography (MCTU) and visual assessment at ureterorenoscopy (URS) for detection of upper tract urothelial carcinoma (UTUC).


METHODS
Consecutive patients referred to our tertiary care centre were included in a prospective study covering the period 2005 to 2012. The patients underwent initial imaging and URS with focal samples taken. Cytopathological results served as reference standard.


RESULTS
We investigated 174 renal units (RUs; renal pelvis and adjacent ureter) in 148 patients. UTUC was found in 104 RUs. MCTU had an accuracy of 0.74, sensitivity of 0.89, specificity of 0.51, positive predictive value of 0.73, and negative predictive value of 0.75; corresponding values for URS were 0.84, 0.84, 0.85, 0.89, and 0.78, respectively. MCTU had significantly higher sensitivity and accuracy compared with other imaging techniques (P<0.05). Compared with MCTU, URS had similar sensitivity but significantly greater specificity and accuracy.


CONCLUSIONS
Both MCTU and URS are important tools in the diagnostic evaluation of UTUC although neither of those techniques achieves 100% accuracy. MCTU should be chosen as the radiographical method if there are no contraindications and URS should always be combined with focal cytology and biopsies of suspicious lesions. To enhance diagnostic precision both MCTU and URS with focal samples should be included in the diagnostic procedure. The present results add impact to current diagnostic guidelines.
Karolinska Institutet, Department of Oncology and Pathology, Stockholm, Sweden.
Alexandra
A
Grahn
Ryhov County Hospital, Department of Urology, Jönköping, Sweden.
Miden
M
Melle-Hannah
Karolinska Institutet, Department of Oncology and Pathology, Stockholm, Sweden.
Camilla
C
Malm
Karolinska University Hospital and Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden.
Fredrik
F
Jäderling
Karolinska University Hospital and Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden.
Eva
E
Radecka
Karolinska University Hospital and Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden.
Mats
M
Beckman
Karolinska Institutet, Department of Oncology and Pathology, Stockholm, Sweden.|Department of Urology, Aarhus University Hospital, Aarhus, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Marianne
M
Brehmer
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014516:Ureteral Neoplasms / Q000000981:diagnostic imaging*; D018666:Ureteroscopy; D014567:Urography / Q000379:methods*
diagnostic accuracy; multiphase computed tomography urography; upper tract urothelial carcinoma; ureterorenoscopy