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Diagnostic performance of multidetector computed tomographic (MDCTU) in upper tract urothelial carcinoma (UTUC): a systematic review and meta-analysis

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Abstract

Purpose

To systematically review the literature evaluating the performance of MDCTU for the diagnosis of UTUC and meta-analyse available data. We also compared the diagnostic accuracy of MDCTU to other radiologic modalities.

Methods

This systematic review and meta-analysis was conducted according to the PRISMA statement. A systematic research using Pubmed, Scopus, Cochrane, and Web of Science libraries was performed on November 1st, 2018. We included all original articles investigating the performance of MDCTU for the diagnosis of UTUC using histopathology as the reference standard for true positives and an unsuspicious clinical follow-up of at least 1 year for true negatives.

Results

Overall, 13 studies comprising 1233 patients were eligible and included in this systematic review and meta-analysis. In patient-based analyses, the pooled sensitivity and specificity were 92% (CI 0.85–0.96) and 95% (CI 0.88–0.98), respectively. The reported sensitivity in the per-lesion analysis ranged between 91 and 97%. All studies reporting segment-based analysis demonstrated high diagnostic accuracy (> 90%). While one study reported higher accuracy of retrograde ureteropyelography than MDCTU (97% vs. 94%), another study demonstrated an inferior accuracy of intravenous pyelogram compared to MDCTU. Findings on the accuracy of diffusion-weighted magnetic resonance imaging compared to MDCTU were inconsistent.

Conclusion

MDCTU has excellent diagnostic performance in detecting UTUC and ruling-out suspicious upper urinary tract lesions in per-patient and per-lesion-based analyses. We confirm the choice of MDCTU as the radiologic diagnostic modality of choice for work-up of suspicious upper urinary tract lesions providing valuable information in patient counseling, decision-making, and treatment planning.

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Acknowledgements

Mohammad Abufaraj was awarded a European Urological Scholarship Program grant (EUSP/Scholarship S-01-2018).

Author information

Authors and Affiliations

  1. Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Florian Janisch, Shahrokh F. Shariat, Harun Fajkovic, Shoji Kimura, Takehiro Iwata, Philipp Korn & Mohammad Abufaraj

  2. Department of Urology, Medical University of Hamburg, Hamburg, Germany

    Florian Janisch & Michael Rink

  3. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  4. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Shahrokh F. Shariat

  5. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  6. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Shahrokh F. Shariat & Petr V. Glybochko

  7. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Shahrokh F. Shariat

  8. Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    Pascal Baltzer

  9. Department of Urology, Jikei University School of Medicine, Tokyo, Japan

    Shoji Kimura

  10. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Takehiro Iwata

  11. Department of Epidemiology, Medical University of Vienna, Vienna, Austria

    Lin Yang

  12. Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada

    Lin Yang

  13. Department of Community Health Sciences, University of Calgary, Calgary, Canada

    Lin Yang

  14. Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan

    Mohammad Abufaraj

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  1. Florian Janisch
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Contributions

FJ: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. SFS: protocol/project development and manuscript writing/editing. PB: manuscript writing/editing. HF: manuscript writing/editing. SK: data analysis. TI: data collection or management and data analysis. PK: data collection or management. LY: manuscript writing/editing. PVG: manuscript writing/editing. MR: manuscript writing/editing. MA: protocol/project development and manuscript writing/editing.

Corresponding author

Correspondence to Shahrokh F. Shariat.

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Conflict of interest

SF Shariat has a consulting or advisory role for the following: Astellas, Astra Zeneca, Bayer, BMS, Cepheid, Ferring, Ipsen, Jansen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, Richard Wolf, Roche, Sanochemia, Sanofi, Takeda, Urogen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Janisch, F., Shariat, S.F., Baltzer, P. et al. Diagnostic performance of multidetector computed tomographic (MDCTU) in upper tract urothelial carcinoma (UTUC): a systematic review and meta-analysis. World J Urol 38, 1165–1175 (2020). https://doi.org/10.1007/s00345-019-02875-8

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