(UTUC) Upper Tract Urothelial Carcinoma: Special Considerations

Blogger's Note: does not discuss hereditary syndrome (Lynch Syndrome)

open access
 

Diagnosis and Staging

The most common way in which UTUC is diagnosed is through a workup for hematuria. Less frequently, UTUC presents as flank pain, a flank mass, or an incidental finding on imaging obtained for other indications.^11,12 The standard investigation for hematuria includes urinary cytology, upper tract imaging, and cystoscopy.^11,12 First-line upper tract imaging consists of computed tomographic (CT) urography owing to its wide availability and its sensitivity and specificity for kidney stones and UTUC of more than 90%.¹³ In practice, upper tract imaging can be done with any number of alternatives based on resource availability, patient age, pretest risk, and local practice patterns. Although there has been enthusiasm for fluorodeoxyglucose ¹⁸F positron emission tomography/computed tomography (¹⁸FDG-PET/CT) in monitoring for recurrence of UTUC, its role as an initial imaging modality is limited.¹⁴ Similarly, magnetic resonance urography can accurately image soft-tissue lesions in the upper urinary tract and provides an option when iodinated contrast medium is contraindicated.¹⁵ As an initial screening test, urinary cytology has performed poorly, even in patients with high-grade UTUC and even when done in a selective fashion with barbotage.¹⁶ Hydronephrosis is a poor prognostic sign in UTUC, and the degree of hydronephrosis has been shown to be independently correlated with a negative prognosis.¹⁷ Regardless of the modality selected, no imaging method is completely accurate for the staging of localized UTUC or tumors that have spread to regional lymph nodes. Preoperative risk factors, histologic grade, and surgeon discretion all must play a role in the ultimate management of these tumors.....(UTUC)..... .