Takayanagi Akio, Takahashi Atsushi, Fukuta Fumimasa, Okada Manabu, Matsuki Masahiro, Sato Shunsuke, Uehara Teruhisa, Kato Shuichi, Takagi Yoshio
Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan.
Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Asian J Urol. 2016 Jan;3(1):44-48. doi: 10.1016/j.ajur.2015.11.005. Epub 2015 Nov 26.
We evaluated who would need further evaluations such as retrograde pyelography (RP) and/or ureteroscopy to diagnose upper urinary tract urothelial cancers (UUTUCs) when abnormal findings for the upper urinary tract (UUT) were detected by enhanced computed tomography (CT).
We retrospectively analyzed 125 patients who underwent enhanced CT for various reasons and had abnormal findings for the UUT. Patients whose tumors were suspected to be of extraureteral origin were excluded. All patients received RP and/or ureteroscopy to evaluate the UUTUCs.
The median age of the 125 patients was 70 years and gross hematuria (26.4%) was the most frequently observed symptoms. RP, ureteroscopy and both were performed for 121, 59 and 55 patients, respectively. CT revealed tumor-like lesions in 58 patients and the other patients had non-tumor-like lesions. UUTUCs were found in 43 (34.4%) of the 125 patients. All of them had tumor-like lesions on CT. In 58 patients who had tumor-like lesions on CT, univariate and multivariate analyses revealed that tumor diameter and tumor enhancement were significant predictive factors for UUTUCs. ROC curve analysis of enhanced CT to diagnose UUTUCs revealed that a tumor diameter of 18 mm was the best cutoff point. The sensitivity, specificity and accuracy were 90.0%, 98.8% and 92.7% for RP and 95.5%, 100% and 97.1% for ureteroscopy, respectively. Both of them had high sensitivity, specificity and accuracy.
We should decide to evaluate the UUT according to the tumor diameter on enhanced CT. When we evaluate the UUT in patients with tumor diameters of less than 20 mm, ureteroscopy is recommended.
我们评估了在通过增强计算机断层扫描（CT）检测到上尿路（UUT）存在异常发现时，哪些患者需要进一步评估，如逆行肾盂造影（RP）和/或输尿管镜检查，以诊断上尿路尿路上皮癌（UUTUCs）。
我们回顾性分析了125例因各种原因接受增强CT检查且UUT有异常发现的患者。排除肿瘤疑似起源于输尿管外的患者。所有患者均接受RP和/或输尿管镜检查以评估UUTUCs。
125例患者的中位年龄为70岁，肉眼血尿（26.4%）是最常见的症状。分别有121例、59例和55例患者接受了RP、输尿管镜检查以及两者均接受。CT显示58例患者有肿瘤样病变，其他患者有非肿瘤样病变。125例患者中有43例（34.4%）发现UUTUCs。他们在CT上均有肿瘤样病变。在CT上有肿瘤样病变的58例患者中，单因素和多因素分析显示肿瘤直径和肿瘤强化是UUTUCs的重要预测因素。增强CT诊断UUTUCs的ROC曲线分析显示，肿瘤直径18mm是最佳截断点。RP的敏感性、特异性和准确性分别为90.0%、98.8%和92.7%，输尿管镜检查的敏感性、特异性和准确性分别为95.5%、100%和97.1%。两者均具有较高的敏感性、特异性和准确性。
我们应根据增强CT上的肿瘤直径决定是否对上尿路进行评估。当评估肿瘤直径小于20mm的患者的上尿路时，建议进行输尿管镜检查。
