Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract

摘要

＜正＞ Background Transitional cell carcinoma of the upper urinary tract（UUT-TCC）accounts for 5% to 10% of all renaltumours and 5% to 6% of all urothelial tumours all over the world.In China,the proportion of UUT-TCC to all urothelialturnouts may be 26%,which is higher than that in the western world.The early diagnosis of UUT-TCC is difficult and thepresent study elucidates the diagnostic value of poor or nonvisualization（PNV）in intravenous urography in patients withUUT-TCC and its correlations with pathological findings and clinical characteristics.Methods The data of 172 consecutive patients between January 1997 and January 2005 with UUT-TCC whounderwent nephroureterectomy in our departments were selected and analyzed retrospectively.Results Of our sample,144 cases presented with gross haematuria（83.7%）and 12 with microscopic haematuria（7.0%）.Forty-six cases（26.7%）were detectable by cytology.Filling defect identified 36 positive cases of 172 patients（20.9%）,PNV was present in the images of 105 of 172 patients（61.0%）.The detection rate by PNV（61.0%）wassignificantly different from that by cytology（26.7%）or by filling defect（20.9%）（P=0.031,P=0.001,respectively）.Univariate logistic regression analysis for PNV showed that tumour stage,grade and size were significant predictors（P=0.028;P=0.031;P=0.006,respectively）.Tumour stage and size were identified as independent risk factors in themultivariate logistic regression model（P=0.042;P=0.014）.Conclusions Except for suspected urolithiasis,urinary tuberculosis or congenital abnormalities,UUT-TCC should beconsidered if PNV exists in intravenous urography especially of old patients.The value of PNV is much more significantthan filling defect in intravenous urography in the diagnosis of UUT-TCC.It is supposed that PNV carries more risk ofhigher stage and larger tumour size in UTT-TCC.Chin Med J 2007;120（16）:1387-1390