Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Department of Urology, Oslo University Hospital, Oslo, Norway.
Eur Radiol. 2020 Mar;30(3):1664-1670. doi: 10.1007/s00330-019-06521-0. Epub 2019 Nov 20.
Three-phase CT urography (CTU) is the gold standard for evaluating the upper urinary tract in patients with hematuria. We aimed to evaluate the accuracy of CTU for detecting upper urothelial cell carcinomas (UCC) in patients with hematuria and negative cystoscopy. Secondly, we aimed to determine the tumor visibility on each CTU phase.
This retrospective study included all patients with hematuria referred to CTU after a negative cystoscopy during 2016 and 2017. The original CTU reports were dichotomized as negative or positive. All patient charts were reviewed after a minimum of 18-month follow-up in order to register missed cancers. The results of biopsies and clinical follow-up were used as the reference standard. Two reviewers retrospectively evaluated the tumor visibility of each CT sequence in all true-positive CTUs.
We included 376 patients with hematuria who underwent CTU after a negative cystoscopy. Macroscopic and microscopic hematuria occurred in 87% (327) and 13% (49), respectively. The incidence of upper urothelial cell carcinoma was 1.9% (7), and the sensitivity of CTU was 100% (95% CI, 59-100), specificity was 99% (95% CI, 98-100), positive predictive value was 88% (95% CI, 47-99), and negative predictive value was 100% (95% CI, 99-100). The accuracy was 99% (95% CI, 90-100). All UCCs were visible on the nephrographic phase for both reviewers.
CTU is highly accurate for detecting upper UCCs. All cases were seen on the nephrographic phase. This suggests that the CTU protocol can be simplified.
• CT urography is highly accurate for detecting upper urothelial cell carcinomas. • All cancers were seen on the nephrographic phase. • All cancers were detected in patients with macroscopic hematuria.
三期 CT 尿路造影（CTU）是评估血尿患者上尿路的金标准。我们旨在评估 CTU 在检测血尿和阴性膀胱镜检查患者的上尿路上皮细胞癌（UCC）的准确性。其次，我们旨在确定 CTU 各期肿瘤的可见性。
这项回顾性研究包括 2016 年至 2017 年期间因阴性膀胱镜检查而转至 CTU 的所有血尿患者。原始 CTU 报告分为阴性或阳性。所有患者的病历均在至少 18 个月的随访后进行了复查，以登记遗漏的癌症。活检和临床随访的结果被用作参考标准。两名审阅者回顾性评估了所有真阳性 CTU 中每个 CT 序列的肿瘤可见性。
我们纳入了 376 例因阴性膀胱镜检查而接受 CTU 的血尿患者。宏观血尿和微观血尿的发生率分别为 87%（327 例）和 13%（49 例）。上尿路上皮细胞癌的发生率为 1.9%（7 例），CTU 的敏感性为 100%（95%CI，59-100），特异性为 99%（95%CI，98-100），阳性预测值为 88%（95%CI，47-99），阴性预测值为 100%（95%CI，99-100）。准确性为 99%（95%CI，90-100）。两名审阅者均在肾实质期观察到所有 UCC。
CTU 高度准确地检测上 UCC。所有病例均在肾实质期可见。这表明 CTU 方案可以简化。
• CTU 高度准确地检测上尿路上皮细胞癌。 • 所有癌症均在肾实质期可见。 • 所有癌症均在宏观血尿患者中检测到。
