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.
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.
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.
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.
World journal of urology. 2019 Jul 18 [Epub ahead of print]
Florian Janisch, Shahrokh F Shariat, Pascal Baltzer, Harun Fajkovic, Shoji Kimura, Takehiro Iwata, Philipp Korn, Lin Yang, Petr V Glybochko, Michael Rink, Mohammad Abufaraj
Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria., Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. ., Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria., Department of Epidemiology, Medical University of Vienna, Vienna, Austria., Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Department of Urology, Medical University of Hamburg, Hamburg, Germany.