上泌尿道上皮癌病理特徵對於正子斷層檢查診斷正確率之影響
林于巧、詹皓程、歐建慧、楊文宏
國立成功大學附設醫院 泌尿部
Pathological characteristic of upper urinary tract urothelial carcinoma undetected on Fluorodeoxyglucose positron emission tomography /computed tomography (18F-FDG PET-CT)
Yu-Chiao Lin, Hau-Chern Jan, Chien-Hui Ou, Weng-Horng Yang
Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
Purpose:
Fluorodeoxyglucose positron emission tomography /computed tomography (18F-FDG PET-CT) has been introduced to be the diagnostic tools of upper urinary tract urothelial carcinoma. However, in some cases, the ureteral lesions were undetected on 18F-FDG PET-CT and needed CT or other diagnostic tools. Therefore, investigating the risk factor causing 18F-FDG PET-CT false negative became important and may affect the patient’s treatment.
Materials and Methods:
We retrospectively reviewed the medical records of 52 patients who received 18F-FDG PET-CT for suspected upper tract urothelial carcinoma between Aug, 2011 and Dec, 2017 in a single medical center in Taiwan. Patients received radical nephroureterectomy after either 18F-FDG PET-CT or CT revealed highly suspected upper tract urothelial carcinoma. Totally 52 patients were included and 60 lesions were pathological proved to be urothelial carcinoma. The characteristic of these patients and their lesions were analyzed using t-test.
Results:
Totally 52 patients were included and 60 lesions were enrolled. The sensitivity of primary tumor by PETCT is 83%. 10 lesions were missed by PET-CT but were confirmed during pathological exam. There were 4,5,1 missed lesions of pTa, pT1 and pT3 respectively. Patients younger than 55-year-old or with multiple lesions have significantly more number of lesions undetectable on PET-CT. Lesions with early pT stage, tumor size less than 3cm or concomitant ipsilateral ureteral lesions have significantly higher false negative rate on PET-CT. The significance was demonstrated especially when ipsilateral ureteral lesions has higher pathological T stage (P<0.001).
Conclusion:
18F-FDG PET-CT is a useful diagnostic tool in detection of UTUC. However, in case with multiple ureteral lesions, increasing rate of false negative 18F-FDG PET-CT result should be aware. Especially if the lesion had early pT stage and small size.