TY - JOUR
T1 - Diagnostic Accuracy of Clinical Lymph Node Staging for Upper Tract Urothelial Cancer Patients
T2 - A Multicenter, Retrospective, Observational Study
AU - Pallauf, Maximilian
AU - D'Andrea, David
AU - König, Frederik
AU - Laukhtina, Ekaterina
AU - Yanagisawa, Takafumi
AU - Rouprêt, Morgan
AU - Daneshmand, Siamak
AU - Djaladat, Hooman
AU - Ghoreifi, Alireza
AU - Soria, Francesco
AU - Fujita, Kazutoshi
AU - Boorjian, Stephen A.
AU - Potretzke, Aaron M.
AU - Mari, Andrea
AU - Roumiguié, Mathieu
AU - Antonelli, Alessandro
AU - Bianchi, Alberto
AU - Khene, Zine Eddine
AU - Sfakianos, John P.
AU - Jamil, Marcus
AU - Boormans, Joost L.
AU - Raman, Jay D.
AU - Grossmann, Nico C.
AU - Breda, Alberto
AU - Heidenreich, Axel
AU - Del Giudice, Francesco
AU - Singla, Nirmish
AU - Shariat, Shahrokh F.
AU - Pradere, Benjamin
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Purpose:Treatment options for the management of upper tract urothelial cancer are based on accurate staging. However, the performance of conventional cross-sectional imaging for clinical lymph node staging (N-staging) remains poorly investigated. This study aims to evaluate the diagnostic accuracy of conventional cross-sectional imaging for upper tract urothelial cancer N-staging.Materials and Methods:This study was a multicenter, retrospective, observational study. We included 865 nonmetastatic (M0) upper tract urothelial cancer patients treated with curative intended surgery and lymph node dissection who had been staged with conventional cross-sectional imaging before surgery. We compared clinical (c) and pathological (p) N-staging results to evaluate the concordance of node-positive (N+) and node-negative (N0) disease and calculate cN-staging's diagnostic accuracy.Results:Conventional cross-sectional imaging categorized 750 patients cN0 and 115 cN+. Lymph node dissection categorized 641 patients pN0 and 224 pN+. The cN-stage was pathologically downstaged in 6.8% of patients, upstaged in 19%, and found concordant in 74%. The sensitivity and specificity of cN-staging were 25% (95% CI 20; 31) and 91% (95% CI 88; 93). Positive and negative likelihood ratios were 2.7 (95% CI 2.0; 3.8) and 0.83 (95% CI 0.76; 0.89). The area under the receiver operating characteristics curve (0.58, 95% CI 0.55; 0.61) revealed low diagnostic accuracy.Conclusions:Conventional cross-sectional imaging had low sensitivity in detecting upper tract urothelial cancer pN+ disease. However, cN+ increased the likelihood of pN+ by almost threefold. Thus, conventional cross-sectional imaging is a rule-in but not a rule-out test. Lymph node dissection should remain the standard during extirpative upper tract urothelial cancer surgery to obtain accurate N-staging. cN+ could be a strong argument for early systemic treatment.
AB - Purpose:Treatment options for the management of upper tract urothelial cancer are based on accurate staging. However, the performance of conventional cross-sectional imaging for clinical lymph node staging (N-staging) remains poorly investigated. This study aims to evaluate the diagnostic accuracy of conventional cross-sectional imaging for upper tract urothelial cancer N-staging.Materials and Methods:This study was a multicenter, retrospective, observational study. We included 865 nonmetastatic (M0) upper tract urothelial cancer patients treated with curative intended surgery and lymph node dissection who had been staged with conventional cross-sectional imaging before surgery. We compared clinical (c) and pathological (p) N-staging results to evaluate the concordance of node-positive (N+) and node-negative (N0) disease and calculate cN-staging's diagnostic accuracy.Results:Conventional cross-sectional imaging categorized 750 patients cN0 and 115 cN+. Lymph node dissection categorized 641 patients pN0 and 224 pN+. The cN-stage was pathologically downstaged in 6.8% of patients, upstaged in 19%, and found concordant in 74%. The sensitivity and specificity of cN-staging were 25% (95% CI 20; 31) and 91% (95% CI 88; 93). Positive and negative likelihood ratios were 2.7 (95% CI 2.0; 3.8) and 0.83 (95% CI 0.76; 0.89). The area under the receiver operating characteristics curve (0.58, 95% CI 0.55; 0.61) revealed low diagnostic accuracy.Conclusions:Conventional cross-sectional imaging had low sensitivity in detecting upper tract urothelial cancer pN+ disease. However, cN+ increased the likelihood of pN+ by almost threefold. Thus, conventional cross-sectional imaging is a rule-in but not a rule-out test. Lymph node dissection should remain the standard during extirpative upper tract urothelial cancer surgery to obtain accurate N-staging. cN+ could be a strong argument for early systemic treatment.
KW - carcinoma
KW - diagnostic imaging
KW - lymphatic metastasis
KW - transitional cell
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U2 - 10.1097/JU.0000000000003085
DO - 10.1097/JU.0000000000003085
M3 - Article
C2 - 36475808
AN - SCOPUS:85147783364
SN - 0022-5347
VL - 209
SP - 515
EP - 524
JO - Journal of Urology
JF - Journal of Urology
IS - 3
ER -