Trends in the utilization of diagnositics for upper-tract urothelial carcinoma.

Abstract

348 Background: The evolution and adoption of better endoscopes and imaging allow for improved diagnostic capacity for upper tract urothelial cancer (UTUC). We evaluated the changes in diagnostic modalities used to establish a diagnosis of UTUC. Additionally, we assessed how these changes affected the stage of patients receiving definitive surgery. Methods: Using linked SEER-Medicare data from 1992-2009, we identified patients between the age of 66-90 who underwent surgical treatment for UTUC. Among this cohort we assessed the types of diagnostics: endoscopy, computed tomography urogram (CTU), magnetic resonance urography (MRU), intravenous pyelogram (IVP), and retrograde pyelogram (RGP), used to evaluate their disease. Additionally, we dichotomized the final stage at surgery as lower stage disease (Ta, CIS, or unknown stage) or higher-stage disease (T1 or greater). Tests for trend were calculated for the five diagnostic modalities. Logistic regression models were fit to determine the impact of diagnostic modalities on stage at surgery. Results: We found a downward trend in utilization of IVP and RPG over time (p < 0.001, p = 0.011) with IVP having largest decline in use. Endoscopy, CTU and MRU all demonstrated increased utilization over time (p <0.0001). The incidence of lower stage disease was not found to be changing over time (p = 0.123). Logistic regression analysis demonstrated that among modern use (2000-2009), only the use of endoscopy and IVP were associated with smaller tumors (CI 1.310-1.996, CI 1.150-1.720). Conclusions: Modern diagnostics (endoscopy, CTU, MRU) have supplanted traditional methods of establishing a diagnosis of UTUC. Although these newer adopted technologies have a greater sensitivity in diagnosis of UTUC, only the use of endoscopy prior to definitive management has been associated with the diagnosis of smaller tumors.