Aims and objectives
Current guidelines in our trust recommend ultrasound (US) as the initial imaging modality in the investigation of painless macroscopic haematuria.
We aimed to consider the effectiveness of this current pathway by determining the sensitivity of US and CT in detecting upper tract transitional cell carcinomas (TCCs).
We also aimed to determine the time taken to diagnose of upper tract TCCs and determine causes of delayed diagnoses.
We identified discrepant cases so that we could present these findings to our local radiology and urology departmentsas a...
Methods and materials
We conducted a retrospective review of patients diagnosed with upper tract TCCs over a 5 year period from 2013-2017.
Initially,
we accessed the pathology database to identify all patients who underwent nephro-ureterectomy with a subsequent diagnosis of TCC during this time period.
Patients with metastatic disease or those who underwent ureteroscopic laser treatment for upper tract TCCs were not included in analysis.
All scans prior to the date of surgery that included the renal tract were reviewed.
Discrepant cases were highlighted and the sensitivity of...
Results
A total of 37 patients were included. The tumour sites included: ureter (15 patients),
renal pelvis (12),
renal calyx (4),
renal parenchymal infiltration (6) (See figure 1).
US scans were performed as an initial investigation in 23 patients.
15 of these patients were referred through the one stop macroscopic haematuria clinical pathway.
Tumour was correctly identified in 3 and hydronephrosis identified in 13 cases.
We concluded that US had sensitivity for detecting TCCs of 13% and a sensitivity of 70% for detecting any renal abnormality...
Conclusion
The sensitivity of ultrasound for detecting upper tract TCCs is low (13%) which is potentially related to user technique and the limited assessment of the ureter on ultrasound.
Conversely,
CT has excellent sensitivity for detecting upper tract TCCs (100%) but our pick up rate was 84%.
The low sensitivity of US and diagnostic misses by radiologists has contributed to delays in diagnosing upper tract TCCs.
Common pitfalls in identifying these tumours included not recognising hyperattenuating lesions within the renal collecting system and not identifying ureteric...
Personal information
Dr P Burn,
Consultant Radiologist,
Radiology Department,
Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
Dr H O'Brien,
Radiology Registrar,Radiology Department,
Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
Dr N Burns-Cox,
Consultant Urologist,
Urology Department,Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
Dr J Brown,Consultant Radiologist,Radiology Department,
Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
References
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Browne R,
Meehan C,
Colville J,
Power R,
Torreggiani W.
Transitional Cell Carcinoma of the Upper Urinary Tract: Spectrum of Imaging Findings.
Education Exhibit Radiographics 2005; 25:1609 –1627.