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International braz j urol

Print version ISSN 1677-5538

Int. braz j urol. vol.36 no.5 Rio de Janeiro Sept./Oct. 2010

http://dx.doi.org/10.1590/S1677-55382010000500018 

UROLOGICAL SURVEY

 

Imaging

 

Tumor characteristics of urothelial carcinoma on multidetector computerized tomography urography

 

Wang LJ, Wong YC, Ng KF, Chuang CK, Lee SY, Wan YL
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
J Urol. 2010; 183: 2154-60

Purpose: We investigated the relationship between tumor characteristics of urothelial carcinoma and detectability on multidetector computerized tomography urography.
Materials and Methods: We retrospectively reviewed all adult consecutive patients with hematuria who underwent multidetector computerized tomography urography during a 23-month period at our hospital. Patients with a final diagnosis of urothelial carcinoma verified by histological examination of surgical specimens were included in the study. The presence and location of urothelial carcinomas on multidetector computerized tomography urography without knowledge of final diagnosis were recorded. Tumor characteristics (location, size, histological classification and stage) were recorded based mainly on histological findings. The association between tumor characteristics and urothelial carcinoma detectability on multidetector computerized tomography urography was analyzed.
Results: A total of 70 patients who underwent multidetector computerized tomography urography had 87 verified urothelial carcinomas. Of these carcinomas 6 (6.9%) were undetectable by multidetector computerized tomography urography, including 5 ureteral and 1 bladder urothelial carcinoma. Size of detectable and nondetectable tumors on multidetector computerized tomography urography differed significantly (3.05 +/- 1.79 vs 0.65 +/- 0.99 cm, respectively, p = 0.001). Tumor location (p = 0.009), tumor size 1 cm or larger (p = 0.003) and noncarcinoma in situ tumors (p = 0.001) were significantly associated with multidetector computerized tomography urography detectability. Conversely organ confined disease had no association with multidetector computerized tomography urography detectability. Multivariate analyses showed that noncarcinoma in situ tumor was a significant predictor of multidetector computerized tomography urography detectability (p = 0.001).
Conclusions: Multidetector computerized tomography urography is useful for detecting nearly all urothelial carcinomas in adults with hematuria. Careful assessment by multidetector computerized tomography urography is needed to detect small (less than 1 cm) or ureteral urothelial carcinomas. It remains a challenge to detect carcinoma in situ tumors by multidetector computerized tomography urography. Thus, negative results of urothelial carcinomas on multidetector computerized tomography urography do not exclude the presence of carcinoma in situ tumors.

Editorial Comment

Multidetector CT-urography (MDCT-urography) has been shown to be an effective single comprehensive examination in the evaluation of patients with hematuria or with risk for the development of urothelial malignancies. In this manuscript a total of 201 adults underwent MDCT- urography as imaging investigation of hematuria. Interesting point to consider is number of patients in whom this test was important to determine the etiology of hematuria. Seventy patients (34%), had urothelial cancer and other 88(43%) had other urological abnormalities responsible for the hematuria. Specifically in patients with urothelial cancer, 85.7% presented with gross hematuria and 14.3% presented with microscopic hematuria. These results emphasize the value of MDCT-urography as a tool for investigation of either gross or microscopic hematuria particularly in older patients. In this series 7 % of tumors were undetectable by MDCT- urography, including 5 ureteral and 1 bladder urothelial carcinoma. There are a variety of reasons for false-negative diagnoses of ureteral and bladder cancer during MDCT- urography. Early-enhanced thin-section MDCT of a full bladder with urine can decrease the number of false negatives bladder studies. This "bladder -wall phase ", obtained 60 seconds after contrast injection has superior accuracy for detection of small lesions in comparison with the excretory phase alone (bladder fully distended by opacified urine), as used by the authors. However small flat tumors that do not appear as filling defects and carcinoma in situ tumors, are almost impossible to be detected by MDCT-urography. For this reason, although not a perfect test, cystocopy remains the reference standard procedure in the investigation of hematuria.

Dr. Adilson Prando
Head, Department of Radiology and
Diagnostic Imaging, Vera Cruz Hospital
Campinas, São Paulo, Brazil
E-mail: adilson.prando@gmail.com

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