Diagnostic Accuracy of Qualitative and Quantitative Computed Tomography Analysis for Diagnosis of Pathological Grade and Stage in Upper Tract Urothelial Cell Carcinoma

Objective The aim of this study was to compare grade and stage of upper tract urothelial cell carcinoma (UCC) using computed tomography. Materials and Methods With institutional review board approval, 48 patients with 49 UCC (44 high grade and 5 low grade, 26 ⩽ T1 and 23 ≥ T2) underwent nephroureterectomy and preoperative computed tomography between 2013 and 2015. Two blinded radiologists assessed for tumor appearance (filling defect/mass or wall thickening/stricture), margin (smooth or spiculated/irregular), texture (homogeneous, heterogeneous), hydronephrosis, and calcification. A third blinded radiologist established consensus. A fourth blinded radiologist measured size and first-order histogram texture features. Comparisons were performed using &khgr;2 test, multivariable logistic regression, and receiver operator characteristic analysis. Results There was no difference in size of tumors compared by grade or stage (P = 0.80 and 0.13, respectively). Among subjective variables, only tumor texture was significantly different between low- and high-grade UCC (P = 0.03; &kgr; = 0.45). Tumors characterized as spiculated/irregular margin (P = 0.003; 0.30) and heterogeneous (P < 0.001; &kgr; = 0.45) were associated with T2 disease or higher. Entropy was greater in higher grade (6.23 ± 0.46 vs 5.72 ± 0.28) and T2 disease or higher (6.40 ± 0.33 vs 5.95 ± 0.48), (P = 0.03 and 0.02, respectively) with no differences in Kurtosis or Skewness (P > 0.05). Area under the receiver operator characteristic curve for entropy to diagnose high-grade and T2 tumors or higher was 0.83 (confidence interval, 0.64–1.0) and 0.79 (confidence interval 0.59–0.98), respectively. Conclusions Heterogeneity, assessed qualitatively and quantitatively, is accurate for diagnosis of higher grade and stage of disease in upper tract UCC. Spiculated/irregular margins are also associated with T2 disease or higher.

[1]  Hao Sun,et al.  Quantitative CT texture analysis for evaluating histologic grade of urothelial carcinoma , 2017, Abdominal Radiology.

[2]  A. Rosenkrantz,et al.  MRI Evaluation of the Urothelial Tract: Pitfalls and Solutions. , 2016, AJR. American journal of roentgenology.

[3]  Holger Moch,et al.  The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours. , 2016, European urology.

[4]  W. Shabana,et al.  Diagnosis of Sarcomatoid Renal Cell Carcinoma With CT: Evaluation by Qualitative Imaging Features and Texture Analysis. , 2015, AJR. American journal of roentgenology.

[5]  Nicola Schieda,et al.  Can Quantitative CT Texture Analysis be Used to Differentiate Fat-poor Renal Angiomyolipoma from Renal Cell Carcinoma on Unenhanced CT Images? , 2015, Radiology.

[6]  K. Awai,et al.  T categorization of urothelial carcinomas of the ureter with CT: preliminary study of new diagnostic criteria proposed for differentiating T2 or lower from T3 or higher. , 2015, AJR. American journal of roentgenology.

[7]  R. Montironi,et al.  Pathology of Upper Tract Urothelial Carcinoma with Emphasis on Staging , 2014, International journal of immunopathology and pharmacology.

[8]  I. Balslev,et al.  Upper urinary tract tumors: how does the contrast enhancement measured in a split-bolus CTU correlate to histological staging? , 2014, Acta radiologica.

[9]  B. Taouli,et al.  Utility of quantitative MRI metrics for assessment of stage and grade of urothelial carcinoma of the bladder: preliminary results. , 2013, AJR. American journal of roentgenology.

[10]  S. Phipps,et al.  Endoscopic versus laparoscopic management of noninvasive upper tract urothelial carcinoma: 20-year single center experience. , 2013, The Journal of urology.

[11]  A. Shabsigh,et al.  Utility and diagnostic accuracy of ureteroscopic biopsy in upper tract urothelial carcinoma. , 2013, Archives of pathology & laboratory medicine.

[12]  S. Phipps,et al.  Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review , 2012, BJU international.

[13]  G. Sadigh,et al.  Comparative effectiveness of imaging modalities for the diagnosis of upper and lower urinary tract malignancy: a critically appraised topic. , 2012, Academic radiology.

[14]  M. Jinzaki,et al.  Preoperative T categorization and prediction of histopathologic grading of urothelial carcinoma in renal pelvis using diffusion-weighted MRI. , 2011, AJR. American journal of roentgenology.

[15]  M. Remzi,et al.  Upper urinary tract urothelial carcinoma: what have we learned in the last 4 years? , 2011, Therapeutic advances in urology.

[16]  M. Babjuk,et al.  European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. , 2011, European urology.

[17]  F. Montorsi,et al.  Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. , 2009, European journal of cancer.

[18]  Y. Lotan,et al.  Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration , 2009, Cancer.

[19]  A. Nishie,et al.  Gadolinium-enhanced fat-suppressed T1-weighted imaging for staging ureteral carcinoma: correlation with histopathology. , 2007, AJR. American journal of roentgenology.

[20]  Franz Quehenberger,et al.  Multiphasic multidetector-row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract , 2006, European Radiology.

[21]  M. Resnick,et al.  Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinoma. , 2000, Urology.

[22]  M. Babjuk,et al.  Guidelines on Urothelial Carcinomas of the Upper Urinary Tract , 2013 .

[23]  A. Osunkoya,et al.  Accuracy of grading of urothelial carcinoma on urine cytology: an analysis of interobserver and intraobserver agreement. , 2012, International journal of clinical and experimental pathology.

[24]  K. Kihara,et al.  Usefulness of diffusion-weighted MRI in diagnosis of upper urinary tract cancer. , 2011, AJR. American journal of roentgenology.