MP2-13 RADIOGRAPHIC FINDINGS ON CT SCAN ASSOCIATED WITH LYMPH NODE METASTASES IN UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract TCC I1 Apr 2015MP2-13 RADIOGRAPHIC FINDINGS ON CT SCAN ASSOCIATED WITH LYMPH NODE METASTASES IN UPPER TRACT UROTHELIAL CARCINOMA Eugene Cha, Alyssa Yee, Melissa Assel, Maura Micco, John Sfakianos, Philip Kim, Fara Friedman, Itay Sternberg, Daniel Sjoberg, H. Alberto Vargas, and Jonathan Coleman Eugene ChaEugene Cha More articles by this author , Alyssa YeeAlyssa Yee More articles by this author , Melissa AsselMelissa Assel More articles by this author , Maura MiccoMaura Micco More articles by this author , John SfakianosJohn Sfakianos More articles by this author , Philip KimPhilip Kim More articles by this author , Fara FriedmanFara Friedman More articles by this author , Itay SternbergItay Sternberg More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , H. Alberto VargasH. Alberto Vargas More articles by this author , and Jonathan ColemanJonathan Coleman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.136AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is no consensus regarding the indications for lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC) or the extent of LND necessary for adequate staging. We sought to evaluate the performance of various radiographic parameters on CT scan in identifying positive LNs in UTUC patients undergoing radical nephroureterectomy (RNU). METHODS We analyzed chemotherapy-naïve patients treated at our institution from 1997 to January 2013 with RNU and regional LND for UTUC who had pre-operative CT scans within 90 days of surgery available for review. CT scans were evaluated by a radiologist blinded to pathology results. Radiographic characteristics examined included short axis LN diameter, round vs. oval shape, irregular margins, absence of a fatty hilum, marked enhancement, central necrosis, and total number of LNs visualized. Logistic regression and Fisher's exact test were used to assess the agreement between radiographic characteristics and positive LNs on pathology. RESULTS Of 158 patients treated with RNU and LND, 37 (23%) had positive LNs on pathology. The median number LNs identified at time of LND was 8 (IQR 4–15). The sites most often involved with positive LNs were the para-caval and para-aortic regions (13 and 15 patients, respectively). Each of the radiographic characteristics except for the total number of LNs visualized (LN short-axis diameter ≥1.0 cm, LN short-axis diameter ≥0.8 cm plus round shape of LN, round shape of LN, absence of fatty hilum of LN, marked enhancement of LN, central necrosis of LN, irregular margins of LN, and short axis diameter of the largest LN as a continuous variable) was statistically associated with LN pathology when evaluated over all LN regions, but none of the definitions provided strong predictive value. Across the significant radiographic characteristics all positive predictive values were 69% or less and the proportion of false negatives among those with a negative test was at least 12%. CONCLUSIONS We identified radiographic characteristics on CT that are associated with positive pathology at LND during RNU. However, radiographic characteristics could not adequately exclude LN positivity and hence negative imaging does not obviate the need for LND. Prospective studies are needed to assess the distribution of positive LNs in patients with UTUC, stratified by laterality and tumor location, so that LND templates can be standardized. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e15 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Cha More articles by this author Alyssa Yee More articles by this author Melissa Assel More articles by this author Maura Micco More articles by this author John Sfakianos More articles by this author Philip Kim More articles by this author Fara Friedman More articles by this author Itay Sternberg More articles by this author Daniel Sjoberg More articles by this author H. Alberto Vargas More articles by this author Jonathan Coleman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...