The researchers concluded that 71 out of 85 low T stage (Ta-T2) tumors were correctly detected by multidetector CTU, whereas 30 out of 40 advanced T stage (T3-T4) tumors were correctly diagnosed by multidetector CTU. Multidetector CTU led to understaging in 8% (10/125) of tumors and overstaging in 11.2% (14/125) of tumors. The overall accuracy of multidetector CTU in the diagnosis of low and advanced T stage tumors was 80.8% (101/125 patients). The sensitivity for advanced T stage tumors was 75% (30/40), the specificity was 83.5% (71/85), and the positive and negative predictive values were 68.1% (30/44) and 87.6% (71/81), respectively. Distant metastases can also be evaluated for at the same time as local disease staging on CTU. Because of the rarity of metastatic UTUC, few studies have reported the predictors of metastatic patterns. The presence of enlarged lymph nodes can be suggestive of metastases [31]. Limited original research looking at nodal disease on CT specifically in UTUC separate from bladder UC is available. A study of 233 patients by Goodfellow et al [90] found the sensitivity and specificity of CT for pelvic lymph node involvement in bladder UC were 45% and 98%, respectively. Studies looking at the frequency of metastases in UTUC found, in a case series of 250 patients with UTUC, that 56 (22.4%) presented with stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%) [120]. The incidence of lymph node involvement does not seem to be related to the location of the UTUC. Some of the original data for pretreatment staging of renal cell carcinoma involving the pelvis and UTUC arising in the renal pelvis have been traditionally reported together, which makes separating the true sensitivity and specificity for UTUC in this region difficult to accurately evaluate.
Pretreatment Staging of Urothelial Cancer. The researchers concluded that 71 out of 85 low T stage (Ta-T2) tumors were correctly detected by multidetector CTU, whereas 30 out of 40 advanced T stage (T3-T4) tumors were correctly diagnosed by multidetector CTU. Multidetector CTU led to understaging in 8% (10/125) of tumors and overstaging in 11.2% (14/125) of tumors. The overall accuracy of multidetector CTU in the diagnosis of low and advanced T stage tumors was 80.8% (101/125 patients). The sensitivity for advanced T stage tumors was 75% (30/40), the specificity was 83.5% (71/85), and the positive and negative predictive values were 68.1% (30/44) and 87.6% (71/81), respectively. Distant metastases can also be evaluated for at the same time as local disease staging on CTU. Because of the rarity of metastatic UTUC, few studies have reported the predictors of metastatic patterns. The presence of enlarged lymph nodes can be suggestive of metastases [31]. Limited original research looking at nodal disease on CT specifically in UTUC separate from bladder UC is available. A study of 233 patients by Goodfellow et al [90] found the sensitivity and specificity of CT for pelvic lymph node involvement in bladder UC were 45% and 98%, respectively. Studies looking at the frequency of metastases in UTUC found, in a case series of 250 patients with UTUC, that 56 (22.4%) presented with stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%) [120]. The incidence of lymph node involvement does not seem to be related to the location of the UTUC. Some of the original data for pretreatment staging of renal cell carcinoma involving the pelvis and UTUC arising in the renal pelvis have been traditionally reported together, which makes separating the true sensitivity and specificity for UTUC in this region difficult to accurately evaluate.