Scolieri M J, Paik M L, Brown S L, Resnick M I
Department of Urology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, Ohio, USA.
Urology. 2000 Dec 20;56(6):930-4. doi: 10.1016/s0090-4295(00)00800-1.
Computed tomography (CT) of the abdomen and pelvis has been used for staging of upper tract urothelial carcinoma. This study was initiated to evaluate the utility of this modality in guiding the management of patients with upper tract urothelial malignancies.
We performed a retrospective chart review of 37 consecutive patients with urothelial carcinoma of the upper urinary tract (21 renal pelvic, 16 ureteral) who underwent preoperative CT staging of the abdomen and pelvis before open surgical management.
CT was not required to establish the diagnosis in any of the patients, but in 16.2% helped to confirm the diagnosis when the disease was suspected based on other studies. CT accurately provided evidence of metastatic disease in only 3% of the patients. CT was accurate in predicting pathologic TNM stage in 59. 5% of patients. The study understaged or did not detect in 16.2% and 24.3%, respectively. Most importantly, CT did not alter the management of any patient.
CT was rarely helpful in establishing the diagnosis of the upper tract urothelial carcinoma and did not influence the management of any patient. We conclude that preoperative CT scan in those patients who are to undergo open surgical management of confirmed urothelial malignancies of the upper urinary tract without suspicion of advanced disease will rarely influence the management of the disease and its use should be selective and not routine.
腹部和盆腔计算机断层扫描（CT）已用于上尿路尿路上皮癌的分期。本研究旨在评估该检查方式在指导上尿路尿路上皮恶性肿瘤患者治疗中的作用。
我们对37例连续的上尿路尿路上皮癌患者（21例肾盂癌，16例输尿管癌）进行了回顾性病历审查，这些患者在接受开放手术治疗前均接受了腹部和盆腔的术前CT分期。
所有患者均无需CT来确诊，但在16.2%的患者中，当基于其他检查怀疑患有该病时，CT有助于确诊。CT仅在3%的患者中准确提供了转移疾病的证据。CT在59.5%的患者中准确预测了病理TNM分期。该研究分别在16.2%和24.3%的患者中分期过低或未检测到病变。最重要的是，CT未改变任何患者的治疗方案。
CT在确诊上尿路尿路上皮癌方面很少有帮助，且未影响任何患者的治疗。我们得出结论，对于那些将接受确诊的上尿路尿路上皮恶性肿瘤开放手术治疗且无晚期疾病怀疑的患者，术前CT扫描很少会影响疾病的治疗，其使用应具有选择性而非常规性。
