Diagnostic Accuracy of Qualitative and Quantitative Computed Tomography Analysis for Diagnosis of Pathological Grade and Stage in Upper Tract Urothelial Cell Carcinoma
Diagnostic Accuracy of Qualitative and Quantitative Computed Tomography Analysis for Diagnosis of Pathological Grade and Stage in Upper Tract Urothelial Cell Carcinoma
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DOI：
10.1097/rct.0000000000000664
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发表时间：
2018-03-01
影响因子：
1.3
通讯作者：
Schieda, Nicola
中科院分区：
文献类型：
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作者：
Mammen, Suraj;Krishna, Satheesh;Schieda, Nicola
目的比较2013年至2015年48例上尿路尿路上皮细胞癌（UCC）患者术前CT检查的分级和分期。方法经机构审查委员会批准，48例患者共49个UCC（44个高分级，5个低分级，26个T1和23个T2）接受肾输尿管切除术和术前CT检查。两名设盲放射科医生评估了肿瘤外观（充盈缺损/肿块或管壁增厚/狭窄）、边缘（光滑或毛刺/不规则）、质地（均匀、不均匀）、肾积水和钙化。第三位设盲放射科医生达成共识。第四个盲放射科医生测量的大小和一阶直方图纹理特征。结果肿瘤大小在不同分级和分期之间无显著性差异（P = 0.80和0.13）。在主观变量中，只有肿瘤质地在低级别和高级别UCC之间存在显著差异（P = 0.03; = 0.45）。肿瘤特征为毛刺/边缘不规则（P = 0.003; 0.30）和异质性（P < 0.001; = 0.45）与T2或更高的疾病相关。高级别（6.23 ± 0.46 vs 5.72 ± 0.28）和T2或更高级别（6.40 ± 0.33 vs 5.95 ± 0.48）的熵更大（分别为P = 0.03和0.02），峰度或偏度无差异（P > 0.05）。熵值诊断高级别和T2及以上肿瘤的ROC曲线下面积分别为0.83（可信区间0.64-1.0）和0.79（可信区间0.59-0.98）。毛刺/不规则边缘也与T2或更高的疾病相关。
Objective The aim of this study was to compare grade and stage of upper tract urothelial cell carcinoma (UCC) using computed tomography.Materials and Methods With institutional review board approval, 48 patients with 49 UCC (44 high grade and 5 low grade, 26 T1 and 23 T2) underwent nephroureterectomy and preoperative computed tomography between 2013 and 2015. Two blinded radiologists assessed for tumor appearance (filling defect/mass or wall thickening/stricture), margin (smooth or spiculated/irregular), texture (homogeneous, heterogeneous), hydronephrosis, and calcification. A third blinded radiologist established consensus. A fourth blinded radiologist measured size and first-order histogram texture features. Comparisons were performed using (2) test, multivariable logistic regression, and receiver operator characteristic analysis.Results There was no difference in size of tumors compared by grade or stage (P = 0.80 and 0.13, respectively). Among subjective variables, only tumor texture was significantly different between low- and high-grade UCC (P = 0.03; = 0.45). Tumors characterized as spiculated/irregular margin (P = 0.003; 0.30) and heterogeneous (P < 0.001; = 0.45) were associated with T2 disease or higher. Entropy was greater in higher grade (6.23 0.46 vs 5.72 +/- 0.28) and T2 disease or higher (6.40 +/- 0.33 vs 5.95 +/- 0.48), (P = 0.03 and 0.02, respectively) with no differences in Kurtosis or Skewness (P > 0.05). Area under the receiver operator characteristic curve for entropy to diagnose high-grade and T2 tumors or higher was 0.83 (confidence interval, 0.64-1.0) and 0.79 (confidence interval 0.59-0.98), respectively.Conclusions Heterogeneity, assessed qualitatively and quantitatively, is accurate for diagnosis of higher grade and stage of disease in upper tract UCC. Spiculated/irregular margins are also associated with T2 disease or higher.