MP78-11 POSITIVE PREDICTIVE VALUE OF CT UROGRAPHY FOR UPPER TRACT UROTHELIAL CARCINOMA DIAGNOSIS USING DIAGNOSTIC URETEROSCOPY AS THE REFERENCE STANDARD

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II1 Apr 2017MP78-11 POSITIVE PREDICTIVE VALUE OF CT UROGRAPHY FOR UPPER TRACT UROTHELIAL CARCINOMA DIAGNOSIS USING DIAGNOSTIC URETEROSCOPY AS THE REFERENCE STANDARD Timothy Chan Chang, Ishay Mintz, Yuval Bar-Yosef, Simon Conti, Sophie Barnes, Diego Mercer, Nicola Mabjeesh, Joseph Liao, and Mario Sofer Timothy Chan ChangTimothy Chan Chang More articles by this author , Ishay MintzIshay Mintz More articles by this author , Yuval Bar-YosefYuval Bar-Yosef More articles by this author , Simon ContiSimon Conti More articles by this author , Sophie BarnesSophie Barnes More articles by this author , Diego MercerDiego Mercer More articles by this author , Nicola MabjeeshNicola Mabjeesh More articles by this author , Joseph LiaoJoseph Liao More articles by this author , and Mario SoferMario Sofer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2099AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES CT Urography (CTU) is the initial imaging modality of choice for assessing upper urinary tract pathology, including upper tract urothelial carcinoma (UTUC). However, despite abnormal findings on CTU suggestive of UTUC, follow-up diagnostic ureteroscopy (DURS) is frequently negative. We aim to assess the positive predictive value (PPV) of CTU for UTUC using DURS as the reference standard. METHODS The study group comprised 79 consecutive patients from 2 academic institutions. They had CTU findings of upper tract wall thickening, hydronephrosis, a filling defect and/or contrast enhancement diagnosed in consensus by 2 radiologists as suspicious for UTUC. DURS, with either wash cytology when endoscopically negative or biopsies when endoscopically positive, was used as the reference standard. The results of DURS were classified as UTUC, benign lesions (BL) and no pathological findings (NPF). Statistical analysis was conducted. RESULTS Solitary CTU suspected findings were reported in 45 (57%) patients, including thickness in 8 (10%), hydronephrosis in 5 (6%), filling defect in 30 (38%) and enhancement in 2 (3%). Combinations of suspected findings were reported in 34 (43%) patients. DURS revealed 41 (52%) UTUC, 14 (18%) BL and 24 (30%) NPF. Table shows the calculated PPV. The combination of CTU findings had higher PPV in comparison to solitary findings for detection of UTUC (65% vs 42%, respectively; p<0.05, OR 2.5, 95% CI 1.007-6.28) as well as for overall endoscopic pathological findings (82% vs 60%, respectively; p<0.05, OR 3.1, 95% CI 1.07-9.02). Arbitrary stratification of solitary CTU findings as minor UTUC predictors (PPV<50%: thickening, hydronephrosis and enhancement) and major UTUC predictors (PPV≥50%: filling defect) resulted in a statistically significant better prediction for the major group (p<0.05; OR 7.2, 95% CI 1.39-38.15). CONCLUSIONS The best PPV of CTU diagnosis of UTUC is achieved based on a combination of findings, with filling defect appearing to be the most significant among them. In the absence of filling defect, other CTU findings, such as thickening, hydronephrosis and enhancement, are not predictive for UTUC. We suggest that the need for DURS in these cases should be re-considered in correlation with other data (e.g., cytology, biomarkers, history of heavy smoking, recurrent hematuria, etc.). DURS remains the diagnostic standard for deciding whether or not to proceed to nephroureterectomy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1035 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Timothy Chan Chang More articles by this author Ishay Mintz More articles by this author Yuval Bar-Yosef More articles by this author Simon Conti More articles by this author Sophie Barnes More articles by this author Diego Mercer More articles by this author Nicola Mabjeesh More articles by this author Joseph Liao More articles by this author Mario Sofer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...