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Diagnostic Accuracy of Clinical Lymph Node Staging for Upper Tract Urothelial Cancer Patients: A Multicenter, Retrospective, Observational Study
M. Pallauf, D. D'Andrea, F. König, E. Laukhtina, T. Yanagisawa, M. Rouprêt, S. Daneshmand, H. Djaladat, A. Ghoreifi, F. Soria, K. Fujita, SA. Boorjian, AM. Potretzke, A. Mari, M. Roumiguié, A. Antonelli, A. Bianchi, ZE. Khene, JP. Sfakianos, M....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu pozorovací studie, multicentrická studie, časopisecké články
- MeSH
- karcinom z přechodných buněk * diagnóza chirurgie patologie MeSH
- lidé MeSH
- lymfadenektomie metody MeSH
- lymfatické uzliny diagnostické zobrazování chirurgie patologie MeSH
- nádory močového měchýře * chirurgie MeSH
- retrospektivní studie MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
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.
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology CHU Institut Universitaire du Cancer de Toulouse Toulouse France
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Fundació Puigvert Autonomous University of Barcelona Barcelona Spain
Department of Urology Icahn School of Medicine at Mount Sinai New York New York
Department of Urology Kindai University Faculty of Medicine Osaka Japan
Department of Urology Luzerner Kantonsspital Lucerne Switzerland
Department of Urology Mayo Clinic Rochester Minnesota
Department of Urology Penn State Health Hershey Pennsylvania
Department of Urology The Jikei University School of Medicine Tokyo Japan
Department of Urology University Hospital Zurich Zurich Switzerland
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Rennes Rennes France
Department of Urology University of Texas Southwestern Dallas Texas
Department of Urology UROSUD La Croix du Sud Hospital Quint Fonsegrives France
Department of Urology Weill Cornell Medical College New York New York
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Vattikuti Urology Institute Henry Ford Health System Detroit Michigan
Citace poskytuje Crossref.org
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- $a Pallauf, Maximilian $u Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria $u Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria $1 https://orcid.org/0000000284964506
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- $a 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.
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