Upper Urinary Tract Tumors: Which Diagnostic Methods Are Needed?

Abstract

Objectives: We reviewed the data of patients with upper urinary tract (UUT) tumors to evaluate the effectiveness of diagnostic procedures. Methods: This retrospective study evaluated tumor characteristics, imaging procedures, epidemiological and follow-up data of 113 patients. We analyzed the importance of non-invasive and endoscopic diagnosis in addition to imaging as well as the influence of stage and grade on recurrence rate. Results: Most tumors were urothelial carcinomas (92.9%). The cardinal symptoms were hematuria (40.7%), flank pain (2.7%), and urinary obstruction (14.2%). Forty-seven patients received intravenous urograms (IVUs), 57 retrograde ureteropyelography (RUP), 89 CTs, 6 an MRI. The correct positive tumor identification was reached by IVU in 27/47 patients, by RUP in 50/57, by CT in 74/89, and by MRI in 3/6 patients representing sensitivities of 57.4% (IVU), 87.7% (RUP), 83.1% (CT), and 50% (MRI). Sixty-four patients had urine cytology, which was correctly positive in 60.9% and 56 had a diagnostic ureterorenoscopy, which was correctly positive in 83.9%. During follow-up more than 20% of patients developed a recurrence. Conclusion: In patients with hematuria and flank pain, UUT must be considered a differential diagnosis. UUT to the extent of 76.6% showed more invasive growth (>Ta). Thus, rapid and efficient diagnosis based primarily on imaging is required. Contrast CT scan seems to be the imaging modality with the best performance. However, often only a combination of diagnostic procedures gives a certain diagnosis. Due to the high recurrence rate, close follow-up is needed.

Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper tract urothelial carcinoma

“…Brown et al [41] conducted a retrospective study of 184 UTUC patients undergoing RNU and found that 100%, 71.7%, and 33.8% of G1, G2, and G3 tumors, respectively, were superficial. Maruschke et al [7] reported similar results, although a larger proportion (88%) of the G3 tumors was invasive. Holmäng and Johansson [42] recut and re-evaluated 555 UTUC specimens from patients with no previous or concomitant bladder cancer.…”

“…CTU has higher sensitivity than intravenous urography for diagnosing UTUC [7]. In patients with contraindication for use of contrast medium, magnetic resonance urography can be an option.…”

“…The potential risk of intravesical recurrence after diagnostic URS is well known, although this aspect has not been found to have an impact on overall, cancer-specific, recurrence-free, or metastasis-free survival [54, 55]. Furthermore, Maruschke et al [7] and Chitale et al [56]. studied RNUs that were performed based on radiographic findings and without prior URS.…”

Predictive Value of Preoperative Positive Urine Cytology for Development of Bladder Cancer After Nephroureterectomy in Patients With Upper Urinary Tract Urothelial Carcinoma: A Prognostic Nomogram Based on a Retrospective Multicenter Cohort Study and Systematic Meta-Analysis

“…Considering the selected articles from 2007 to 2021, four studies were retrospective cohort studies (28,30,41), and the remaining were case-control studies (29,(42)(43)(44)(45)(46). There were four studies from China (28,42,45), two studies from America (29,41), one study from Germany (43), two studies from Japan (30,46), and one study from Spain (44). In these studies, nine of them involved the risk of high-grade UUT-UC (28)(29)(30)(41)(42)(43)(44)(45).…”

A Festschrift in Honor of Edward M. Messing, MD, FACS

“…Imaging approaches include CT and MRI with contrast, and cystoscopy or retrograde imaging followed by diagnostic ureteroscopy. These techniques are of limited accuracy in identifying upper tract lesions [ 159–161 ]. For example, white light URS for UTUC diagnosis is only 53% specific for malignant lesions, misdiagnosis can lead to unnecessary radical surgery or a missed opportunity for proper cure [ 160 ].…”