EAU 2018: The Utility of Pre-Operative CT Urography in the Diagnosis of Patients with Suspected Upper Tract Urothelial Cancer
For this study, the authors identified 64 patients who underwent diagnostic ureteroscopy for suspected UTUC between May 18, 2016 to May 18, 2017 at a single institution. The degree of suspicion as stated in the radiology report was categorized as “sure”, ”likely”, ”suspicious”, “possible”, or “unlikely”. These pre-operative findings were correlated with intra-operative diagnosis of UTUC by either biopsy or intra-operative ureteric washings.
Among these 64 patients undergoing CT, the radiological likelihood of UTUC was classified as “sure” (n=17), “likely” (n=6), “suspicious” (n=17), “possible” (n=16), and “unlikely” (n=8). Intra-operatively, 31 patients (48.4%) had a confirmed diagnosis of UTUC. Among these patients, 22 had a positive tissue biopsy, with 9 others had positive cytology from intra-operative ureteric washings but no direct visualization of a lesion. When compared to the degree of pre-operative radiological suspicion, the UTUC diagnoses included 12 (70.5%) for “sure”, two (33.3%) for “likely”, 10 (58.8%) for “suspicious”, 10 (37.5%) for “possible” and 37.5% for “unlikely”.
The authors concluded that this study demonstrated poor correlation between pre-operative degree of radiological suspicion of UTUC and findings at diagnostic ureteroscopy. As such, they suggest that diagnostic ureteroscopy should be performed in in all patients suspected of having UTUC prior to a nephroureterectomy should remain standard of care.
Presented by: Hari L. Ratan, MD, Nottingham City Hospital, Nottingham, United Kingdom
Co-Authors: Ellis R, Scriven S, Lloyd J
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark