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The Impact of Ureteroscopy following Computerized Tomography Urography in the Management of Upper Tract Urothelial Carcinoma

2020; Lippincott Williams & Wilkins; Volume: 205; Issue: 2 Linguagem: Inglês

10.1097/ju.0000000000001370

1527-3792

Andrea Gallioli, Angelo Territo, Asier Mercadé, Matteo Fontana, R. Boissier, Josep María Gaya, Esteban Emiliani, A. Sánchez-Puy, María José Martínez, Joan Palou, Alberto Breda,

Ureteral procedures and complications

No AccessJournal of UrologyAdult Urology1 Feb 2021The Impact of Ureteroscopy following Computerized Tomography Urography in the Management of Upper Tract Urothelial CarcinomaThis article is commented on by the following:Editorial Comment Andrea Gallioli, Angelo Territo, Asier Mercadé, Matteo Fontana, Romain Boissier, Josep Maria Gaya, Esteban Emiliani, Antoni Sánchez-Puy, Maria José Martínez, Joan Palou, and Alberto Breda Andrea GallioliAndrea Gallioli †Correspondence: Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025Barcelona , Spain telephone: +34934169700/+393496645072; E-mail Address: [email protected] Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Department of Clinical Sciences and Community Health, University of Milan, Italy , Angelo TerritoAngelo Territo Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain , Asier MercadéAsier Mercadé Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain , Matteo FontanaMatteo Fontana Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Department of Clinical Sciences and Community Health, University of Milan, Italy , Romain BoissierRomain Boissier Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain Aix-Marseille University, Department of Urology, APHM, La Conception Academic Hospital, Marseille, France , Josep Maria GayaJosep Maria Gaya Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain , Esteban EmilianiEsteban Emiliani Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain , Antoni Sánchez-PuyAntoni Sánchez-Puy Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain , Maria José MartínezMaria José Martínez Fundació Puigvert, Department of Radiology, Autonomous University of Barcelona, Barcelona, Spain , Joan PalouJoan Palou Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain , and Alberto BredaAlberto Breda Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain View All Author Informationhttps://doi.org/10.1097/JU.0000000000001370AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We report the reliability of computerized tomography urography and ureteroscopy in the diagnosis and management of upper tract urothelial carcinoma. Materials and Methods: From 2015 to November 2018 we prospectively collected and retrospectively analyzed 244 cases of ureteroscopy with available preoperative computerized tomography urography. Computerized tomography urography was categorized as positive, suspicious, unlikely and negative. Correspondence between imaging, ureteroscopy and histology was analyzed. The therapeutic indication, based on 2020 EAU Guidelines and patient clinical data, was recorded before and after ureteroscopy. Cohen's Kappa was used for agreement analysis. Logistic regression was used for prediction of positive ureteroscopy. Results: Ureteroscopy was positive for upper tract urothelial carcinoma in 107/115 (93%), 48/77 (62.3%), 15/27 (55.6%) and 12/25 (48%) cases with positive, suspicious, unlikely and negative computerized tomography urography, respectively. On cytohistology the result was confirmed in 164/182 (90.1%) cases. The positive predictive value of a filling defect, stenosis, thickening and hydronephrosis on computerized tomography urography was 87.7% (121/138 cases), 65.6% (21/32), 69.6% (64/92) and 79.7% (59/74), respectively. On multivariate analysis a filling defect (95% CI 2.76–11.5, OR 5.63, p <0.0001) or hydronephrosis (1.04–6.18, OR 2.52, p=0.04) was associated with ureteroscopy outcome. Among cases with positive computerized tomography urography and ureteroscopy, the lesions differed in dimensions (20/107), number (14/107) and site (11/107), for a total of 45/107 (42.1%) cases. The indication of elective treatment changed after ureteroscopy in 37/76 (48.1%) cases (Kappa=0.31), as 17/28 (60.7%), 11/20 (55%) and 11/28 (39.2%) indications were confirmed for endoscopic management, ureterectomy and nephroureterectomy, respectively. Conclusions: The complementary use of computerized tomography urography and ureteroscopy in the diagnostic workup of upper tract urothelial carcinoma should be evaluated. References 1. : European Association of Urology Guidelines on upper urinary tract urothelial carcinoma: 2017 update. Eur Urol 2018; 73: 111. Google Scholar 2. : Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973-2005. BJU Int 2011; 107: 1059. Google Scholar 3. : Ureterorenoscopic biopsy and urinary cytology according to the 2004 WHO classification underestimate tumor grading in upper urinary tract urothelial carcinoma. Urol Oncol 2013; 31: 1166. Google Scholar 4. : Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol 2017; 35: 379. Google Scholar 5. : High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection. J Endourol 2012; 26: 398. Google Scholar 6. : Routine diagnostic ureteroscopy for suspected upper tract transitional-cell carcinoma. J Endourol 2014; 28: 922. Google Scholar 7. : Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta-analysis. BJU Int 2018; 121: 184. Google Scholar 8. : Diagnostic ureteroscopy prior to nephroureterectomy for urothelial carcinoma is associated with a high risk of bladder recurrence despite technical precautions to avoid tumor spillage. World J Urol 2020; 38: 159. Google Scholar 9. : European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol 2020; doi: 10.1016/j.eururo.2020.05.042. Crossref, Google Scholar 10. : A new proposal to risk stratify urothelial carcinomas of the upper urinary tract (UTUCs) in a predefinitive treatment setting: low-risk versus high-risk UTUCs. Eur Urol 2014; 66: 181. Google Scholar 11. : Ureteropyeloscopic diagnosis and treatment of upper urinary tract urothelial malignancies. Urology 1999; 54: 240. Google Scholar 12. : Comparing image perception of bladder tumors in four different Storz professional image enhancement system modalities using the íSPIES App. J Endourol 2016; 30: 602. Google Scholar 13. : Comparison of biopsy devices in upper tract urothelial carcinoma. World J Urol 2019; 37: 1899. Google Scholar 14. : Measurement of observer agreement. Radiology 2003; 228: 303. Google Scholar 15. : Diagnostic accuracy of computed tomography urography and visual assessment during ureterorenoscopy in upper tract urothelial carcinoma. BJU Int 2017; 119: 289. Google Scholar 16. : Positive predictive value of CT urography in the evaluation of upper tract urothelial cancer. A J R Am J Roentgenol 2010; 195: W337. Google Scholar 17. : Significance of upper urinary tract urothelial thickening and filling defect seen on MDCT urography in patients with a history of urothelial neoplasms. A J R Am J Roentgenol 2010; 195: 959. Google Scholar 18. : Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer 2009; 115: 1224. Google Scholar 19. : Impact of diagnostic ureteroscopy on intravesical recurrence in patients undergoing radical nephroureterectomy for upper tract urothelial cancer: a systematic review and meta-analysis. BJU Int 2017; 120: 313. Google Scholar 20. : Impact of diagnostic ureteroscopy on intravesical recurrence and survival in patients with urothelial carcinoma of the upper urinary tract. J Urol 2010; 184: 883. Link, Google Scholar 21. : Adjuvant single-dose upper urinary tract instillation of mitomycin C after therapeutic ureteroscopy for upper tract urothelial carcinoma: a single-centre prospective non-randomized trial. J Endourol 2020; 34: 573. Google Scholar 22. : Primary chemoablation of low-grade upper tract urothelial carcinoma using UGN-101, a mitomycin-containing reverse thermal gel (OLYMPUS): an open-label, single-arm, phase 3 trial. Lancet Oncol 2020; 21: 776. Google Scholar 23. : Correlation between confocal laser endomicroscopy (Cellvizio®) and histological grading of upper tract urothelial carcinoma: a step forward for a better selection of patients suitable for conservative management. Eur Urol Focus 2018; 4: 954. Google Scholar 24. : Diagnostic accuracy of ureteroscopic biopsy in predicting stage and grade at final pathology in upper tract urothelial carcinoma: systematic review and meta-analysis. Eur J Surg Oncol 2020; 46: 1989. Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySharma V, Miest T, Juvet T, Toussi A, Packiam V, Chamie K, Matin S, Boorjian S, Thompson R, Frank I, Tollefson M and Potretzke A (2021) Reply by AuthorsJournal of Urology, VOL. 206, NO. 3, (567-567), Online publication date: 1-Sep-2021.Related articlesJournal of UrologyNov 30, 2020, 12:00:00 AMEditorial Comment Volume 205Issue 2February 2021Page: 392-399Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsx-ray computedtransitional cellureteroscopycarcinomatomographyendoscopyMetricsAuthor Information Andrea Gallioli Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Department of Clinical Sciences and Community Health, University of Milan, Italy †Correspondence: Department of Urology, Autonomous University of Barcelona, Cartagena 340-350, 08025Barcelona , Spain telephone: +34934169700/+393496645072; E-mail Address: [email protected] Equal study contribution. More articles by this author Angelo Territo Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain Equal study contribution. More articles by this author Asier Mercadé Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain More articles by this author Matteo Fontana Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Department of Clinical Sciences and Community Health, University of Milan, Italy More articles by this author Romain Boissier Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain Aix-Marseille University, Department of Urology, APHM, La Conception Academic Hospital, Marseille, France More articles by this author Josep Maria Gaya Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain More articles by this author Esteban Emiliani Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain More articles by this author Antoni Sánchez-Puy Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain More articles by this author Maria José Martínez Fundació Puigvert, Department of Radiology, Autonomous University of Barcelona, Barcelona, Spain More articles by this author Joan Palou Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain More articles by this author Alberto Breda Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain Financial interest and/or other relationship with Karl Storz and Cook Medical. More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement Loading ...