Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinoma

Objectives. Computed tomography (CT) of the abdomen and pelvis has been used for staging of upper tract urothelial carcinoma. This study was initiated to evaluate the utility of this modality in guiding the management of patients with upper tract urothelial malignancies. Methods. We performed a retrospective chart review of 37 consecutive patients with urothelial carcinoma of the upper urinary tract (21 renal pelvic, 16 ureteral) who underwent preoperative CT staging of the abdomen and pelvis before open surgical management. Results. CT was not required to establish the diagnosis in any of the patients, but in 16.2% helped to confirm the diagnosis when the disease was suspected based on other studies. CT accurately provided evidence of metastatic disease in only 3% of the patients. CT was accurate in predicting pathologic TNM stage in 59.5% of patients. The study understaged or did not detect in 16.2% and 24.3%, respectively. Most importantly, CT did not alter the management of any patient. Conclusions. CT was rarely helpful in establishing the diagnosis of the upper tract urothelial carcinoma and did not influence the management of any patient. We conclude that preoperative CT scan in those patients who are to undergo open surgical management of confirmed urothelial malignancies of the upper urinary tract without suspicion of advanced disease will rarely influence the management of the disease and its use should be selective and not routine. UROLOGY 56: 930-934, 2000. (C) 2000, Elsevier Science Inc.