Presentation Authors: Andrea Gallioli*, Alberto Breda, Romain Boissier, Angelo Territo, José Maria Gaya, Pavel Gavrilov, María José Martínez, Asier Mercadé, Federica Regis, Joan Palou Redorta, Barcelona, Spain
Introduction: Contrast enhanced computed tomography (CT) is the gold standard to detect upper tract urothelial carcinoma (UTUC). Recently, a higher rate of bladder recurrence in patients submitted to nephroureterectomy after ureteroscopy (URS) for UTUC has been described. The aim of the study is to report on the correspondence between CT and URS findings and how it influences the therapeutic indication.
Methods: We retrospectively reviewed our Institutional database. From 01/2015 to 09/2018, 101 consecutive patients with available CT were submitted to URS for suspicion of UTUC. All CTs were performed within 40 days before surgery at 1.5-slice thickness. CT result was categorized as positive (n=77) in case of pathologic/suspicious lesions, as negative in case of no/unspecific alterations (n=24). Correspondence between imaging, URS and histology was analyzed. Number, diameter and site of lesions were reported. Therapeutic indication after CT, stratified for low and high risk UTUC according to EAU Guidelines, was recorded. Chi-square test was used for categorical variables.
Results: Eighty-seven (86.1%) patients had a UTUC on histology. CT sensitivity/specificity were 83%/64%, respectively. A filling defect corresponded to UTUC in 59/61 (96.7%) cases. 7/14 (50%) of patients with negative histology had urinary thickness on CT. 15/24 (62.5%) patients with negative CT had a neoplastic lesion on histology. 77 (100%) patients with positive CT had a visible lesion on URS; 72/77 (93.5%) were confirmed on cytology/histology. URS detected 32/72 (44.4%) UTUCs with different characteristics compared to CT (13 bigger/smaller, 9 multifocal and 10 in other sites). So, the sensitivity of CT to characterize UTUC lesions was 46%. CT therapeutic indication was changed after URS in 24/101 (23.7%) patients. According to CT, 30/101 (29.7%) high risk cases should have been treated with nephroureterectomy/ureterectomy. Out of these, surgical treatment was not indicated in 16 (53.3%) cases. On the other hand, 12/71 (17%) patients with no CT indication for surgery underwent a radical intervention (x2 = 9.7; p=0.002). 4/16 (25%) patients were submitted to radical treatment after endoscopic management failure. URS allowed to spare the radical treatment in 12/87 (14%) cases (x2 = 6.6; p=0.01) without UTUC progressions (mean follow-up 13 months).
Conclusions: CT accuracy to characterize UTUC lesions is low. URS should be considered a crucial step in the diagnostic pathway of UTUC even in case of CT-documented high risk tumours, since it may significantly change the treatment indication.