Radiological and cytological detection of renal pelvic transitional-cell carcinoma

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Radiologische und zytologische Diagiiostizieriiiigeines Übergaiigszellkarzinoms des Niercnhcckeiis

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We evaluated US. C'I'. intravenous urogrilphy. rrteriography. retrograde pyelography rnd uririe cytology results in a s e r i ~ of s 2 3 patients witli reiial pelvic traiisitional-cell carcinornas, 14 of \vIioin iiiiderwent US. 17 i . v . urography, 8 CT, 1 5 arteriography. Y retrograde pyelography, arid 17 patients urine cytology. A turnour was identified in 5 patients (36 %) at US, in 11 patierits (61 %) at urography, in 7 (88 '10) nt CT. in 10 patients (67 %) at artcriography, and iii 8 (89 %) at retrograde pyelography. IJrine cytology was assessed as showing changes consistent with Papanicolaou class IIIVin 15 (88 X ) of 17 patients. Wheil renal pelvic cancer is suspected, intravenous urography should be prrforrned as tlie initial radinlogical exarnination and followed by Cl'. which may also identify turnour spread. Arteriography and retrograd^ pyelography are soinetirnes cornplementary investigatioiis. Iiepeated urinary cytology is rnandatory. Our results show that VS alone is unreliable in detectiiig renal pelvic cancer.

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An 23 Patienten, bei denen ein Übergangszellkarzinom des Nierenbeckeiis bestaiid. wurde die diagnostische Wertigkeit der nachfolgend aufgeführten Verfahrcn geprüft: Llltraschall (14 Patienten), i.v. Urographie (171, Cornpiit~rtomographie(8). Arteriographie (15), retrograde Pyclographie (9) und Zytologie des Urins (17). Der Ti~rnornachweisgelang bei der I'ltraschallgruppe in 5 Fälleri (36 X ) , bei Urographie in 1 1 (61 X ) , bei CT iii 7 (88 %). bei Arteriographie in 10 (67 ' k ) und bei retrograder Pyelographie in 8 (89 %). Zytologische Untersiichung des Urins zcigtc Verändeningen gemäß Papanicolaou KI. 111-V bei 15 (88 X ) von 17 Patienten. Bei Verdacht auf Niereiibeckenkarzinom sollte zunächst eine i.v. Lrographie erfolgeil uiid daraufhin eine C'I' zur Feststelluiig der 'I'uinorausbreitiing. Ergänzende Untersuchungen sind iinter I1rnstä.ndcn Arteriographie und retrograde Pyelographie. Eine wiederholte zytologische Untersuchung des Urins ist unumgänglich. Unsere Ergebiiisse zeigen, daß die Cltraschalluntersuchung allein diagnostisch unzuverlässig ist, wenn Verdacht auf ein Nierenbeckenkarzinom besteht. -

Key words

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Transitional cell Kidiiey - Malignancy carcinonia - Ultrasound - Computed torriography Urography - Pyelography - Arteriography - Cytology

Introduclion About 7 % ol' all rnalignant renal neoplasrns. most of which are traiisitionell-cell carcinomas, originale kam the rerial pyelocalyceal mucosa ( I 0).Early in ttie cliriical course these tuinours may only bc radiographically detectable by methods that clearly define the anatorriy of the renal collecting syst.cm. Excretory urography (IVU) and retrograde pyclography (RP) rriay locate the lesion but cannot dctcct cither lncal iiivasion or lymph node metastases. Results of ultrasound (US) have bccn disappointing Fortschr. Köntgenstr. 153.3 (1990)266-270 O (;eorgTliicnic Vorlag Stuttgart . Ncw York

Niere - Übergangszellkarzinom des Nierenbeckens - Ultraschall - i.v. Urographie - Computertomographie - Arteriographie - Pyelographic? - Zytologie

(2. 7, 23). whilo computed toniography (CT) has been suggested to be capable o i detecting and staging renal pelvic carcinonia (3). We coinpared the ability of US, CT, IVU, arteriography and ItP to detect renal pelvic canccr iri a series of 2 3 patients with proven discasc.

Material and Mclhods 'Fwcnty-thrcc patients (15 rnen. 8 wonieri with n rnean agr u r 63. rniige 43. 76. ycars) with a provcn histological diagnosis of renal pelvic traiisilional-cell carciiioiiia werc sncn in our Iiocpit.nl bctwocn lY7G--.lYX8. Fourteen patients (61 %) underwent US. 17 (74 %) IVIJ. 8 13.5 %) (:'T. 15 (65 %)) artcriography. and Y (39 'L) NI'. Uriiit! cylolugy was exaiiiiiir(l i i i 17 pntionts (74 Y , ) .

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Aortngraphy was perforiiicd i n 1 5 patients. aritl iitldilionnl sclcctivc~arleriography i n all but oiir ofthnsc. AI IVI,. plaiii filrns uJt,rr tnkcn bcforc contrast iiijrciion nnd imrnediaitbly alter in,jcction of cciiiirast ( 6 0 m l of 60 ' X ) or 7 6 ' X sorliiini mcglumin aiiiidolrizoatc. i . \ . ) arid 5, 10. nnd I 5 min aftrr inje~:i.ion.Whcrc rnqiiirc~tl.rlelnvrd iilms w r r r 1iikt:ii iip lo 24 hours Iater lo sliciw lntc cscrction ofcoiilrnsl. Tlir diagnosis was coiiiirnicd histopathologic:ally iii 20 pntirnts. 3 hacl a Iiisti,ry suggestive o l cnricnr. dass V (l'apariicoliiou clitssification) cyiciliigy. and positive radicigrnphic lindings. bsing prrviously rstablished criterin I R . 8).tumours wcbi-cb classilied as follows: Stag