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Diagnostic Accuracy Of Transitional Cell Carcinoma On Multidetector Computerized Tomography Urography In Patients With Gross Hematuria

October 17, 2017

UroToday - Our current study proves that multidetector computerized tomography urography (MDCTU) is sensitive and accurate for transitional cell carcinoma (TCC) of the urinary tract in hematuria patients.1 However, I would like to emphasize the limitations of MDCTU in detecting and staging TCC in patients who have undergone surgery, intervention or trauma in the urinary tract days or weeks prior to MDCTU. Recent surgery, intervention or trauma results in inflammatory reactions or direct mucosa/mural injuries of the urinary tract.

These changes appear as wall thickening of the urinary tract on MDCTU, which mimic TCC appearances. 1, 2 Similarly, after resection of gross tumor via transurethreal resection of the bladder tumor or endourological procedures, the urinary wall near to resection site becomes edematous and thus thickened. MDCTU can detect wall thickening appearances in these patients; however, MDCTU cannot diagnose and differentiate thickened wall by muscular invasion of TCC from those of post-surgery effect. 2 Furthermore, increased density and stranding of the fat in the perinephric, periureteric or perivesicular areas are also usually seen on MDCTU in patients after surgery, intervention or trauma. 2 On the other hand, patients of TCC with microscopic invasion to adjacent fat may appear as increased density and stranding of the fat on MDCTU, too. 3

Therefore, it is usually not helpful and even confusing to restage patients with TCC after resection using MDCTU.

References

1. Wang LJ, Wong YC, Chuang CK, Huang CC and Pang ST: Diagnostic accuracy of transitional cell carcinoma on multidetector computerized tomography urography in patients with gross hematuria. J Urol 2009; 181: 524.
2. Schild HH, Zapf S and G. V: Postoperative computed tomography. In: Computed tomography in urology. Edited by HH Schild, FJ Schweden, EK Lang. New York: Thieme Medical Publisher, Inc., pp. 310-323, 1992
3. Schweden FJ, Schild HH and Riedmiller H: Renal tumors in adults. In: Computed tomography in urology. Edited by HH Schild, FJ Schweden, EK Lang. New York: Thieme Medical Publisher, Inc., pp. 135-76, 1992
Li-Jen Wang, MD as part of Beyond the Abstract on UroToday

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