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 Experimental and Clinical Medicine University of Florence Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology Careggi Hospital Florence Italy

Department of Maternal Infant and Urologic Sciences Sapienza University of Rome Policlinico Umberto 1 Hospital Rome Italy

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 Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam The Netherlands

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 Paracelsus Medical University Salzburg University Hospital Salzburg Salzburg Austria

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 University of Verona Azienda Ospedaliera Universitaria Integrata di Verona Verona Italy

Department of Urology Uro Oncology Robot Assisted and Specialized Urologic Surgery University Hospital Cologne Cologne Germany

Department of Urology UROSUD La Croix du Sud Hospital Quint Fonsegrives France

Department of Urology USC Norris Comprehensive Cancer Center University of Southern California Los Angeles California

Department of Urology Weill Cornell Medical College New York New York

Departments of Urology and Oncology The James Buchanan Brady Urological Institute The Johns Hopkins University School of Medicine Baltimore Maryland

Division of Urology Department of Surgical Sciences San Giovanni Battista Hospital University of Studies of Torino Turin Italy

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Urology Department GRC n°5 Predictive Onco Uro AP HP Pitié Salpêtrière Hospital Sorbonne University Paris France

Vattikuti Urology Institute Henry Ford Health System Detroit Michigan

J Urol. 2023 Mar;209(3):462-463. doi: 10.1097/JU.0000000000003129. PubMed

References provided by Crossref.org

Need for and extent of lymph node dissection for upper tract urothelial carcinoma: an updated review in 2023

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