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PD4-07 CLINICAL OUTCOMES OF BOSNIAK IIF CYSTIC RENAL LESIONS: A 5-YEAR RETROSPECTIVE STUDY
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Friday, May 16, 2014
CONCLUSIONS: SMART training reduces fluoroscopy times during unilateral, uncomplicated ureteroscopy for urolithiasis performed by urology residents. Source of Funding: none
PD4-06 18
THE VALUE OF F-FDG PET/CT IN STAGING OF UPPER TRACT UROTHELIAL CARCINOMA: IMPACT ON PATIENT MANAGEMENT Hajime Tanaka*, Soichiro Yoshida, Tokyo, Japan; Yoshinobu Komai, Chiba, Japan; Tatsuro Hayashi, Mizuaki Sakura, Shinji Urakami, Tokyo, Japan; Yasuyuki Sakai, Chiba, Japan; Takeshi Yuasa, Shinya Yamamoto, Hitoshi Masuda, Iwao Fukui, Junji Yonese, Yasuhisa Fujii, Kazunori Kihara, Tokyo, Japan INTRODUCTION AND OBJECTIVES: 18F-FDG PET/CT is widely used to diagnose metastases in many kinds of cancer, including bladder cancer. It may also be useful in patients with upper tract urothelial carcinoma (UTUC); however, the utility of PET/CT in the management of UTUC has not been reported. In the current study, the clinical course of patients with UTUC who underwent PET/CT was retrospectively analyzed to investigate its clinical value and impact on patient management. METHODS: Between October 2012 and September 2013, 59 consecutive patients with UTUC underwent 18F-FDG PET/CT for initial staging (n ¼ 48) or restaging (n ¼ 11) following conventional CT or MRI. The imaging findings were validated using histopathology or serial imaging, and the diagnostic accuracy of PET/CT and CT/MRI for detecting metastases were assessed and compared statistically using McNemar0 s test in both patient-based and lesion-based analyses. In addition, the clinical impact of PET/CT on patient management was analyzed by comparing questionnaires that were completed by the attending physicians before and after PET/CT. RESULTS: In the patient-based analysis, 26 (44%) of the 59 patients were diagnosed as having metastases. The sensitivity/specificity/accuracy were 96%/94%/95% in PET/CT and 81%/88%/85% in CT/MRI. The accuracy of PET/CT was significantly superior to CT/MRI (P ¼ 0.031). There were 212 lesions analyzed in 59 patients. In the lesion-based analysis, 179 (84%) of the 212 lesions were diagnosed as metastases. PET/CT had a significantly better sensitivity (77%) than CT/MRI (57%, P <0.0001). Fifty lesions (35 lymph nodes, 1 pulmonary lesion, 12 bone lesions, 1 hepatic lesion and 1 peritoneal dissemination) were detected using PET/CT but were not detected using CT/MRI, and all of these lesions were finally diagnosed as metastases. The clinical impact analysis indicated that clinicians changed their assessments of the disease extent in 21/59 (36%) patients and their treatment plans in 12/59 (20%) patients (Figure) based on the PET/CT results. CONCLUSIONS: This is the first study to show the diagnostic performance of 18F-FDG PET/CT for UTUC. The diagnostic accuracy of PET/CT for detecting metastasis is excellent. Moreover, PET/CT provides additional information compared to CT/MRI that has a beneficial impact on the patients0 clinical management.
Source of Funding: None.
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PD4-07 CLINICAL OUTCOMES OF BOSNIAK IIF CYSTIC RENAL LESIONS: A 5-YEAR RETROSPECTIVE STUDY Krystal Leong, Jeanne Darbinian, Oakland, CA; Jay Belani*, San Rafael, CA INTRODUCTION AND OBJECTIVES: The Bosniak renal cyst classification system is used to stratify renal cysts into their risk of malignancy. Bosniak I and II cysts are considered benign. Bosniak III and IV cysts are considered to have a high malignant potential. A Bosniak IIF renal cyst cannot clearly be categorized and needs followup imaging, but current literature offers scant data on the natural course of a IIF cyst, and there is no clear guideline on how best to follow these lesions. The objective of our study is to assess the radiologic progression and 5-year outcomes of Bosniak IIF renal lesions. METHODS: We retrospectively identified 860 patients from January 1, 2005 through December 31, 2007 who had a possible complex renal cyst on computed tomography scan (CT), magnetic resonance imaging (MRI), or ultrasound (US). All reports which contained the words “Bosniak” or “complex” and “renal cyst” were included in the study population. Cysts were verified by CT or MRI if initial imaging was an ultrasound. Patients were included in the study cohort if they were confirmed to have a Bosniak IIF cyst and had at least 5 years of follow-up data. Of the 860 eligible patients, 112 met the inclusion criteria. Over a 5 year period, each patient was evaluated for transformation, defined as progression of Bosniak category on follow-up imaging, surgical or percutaneous treatment of the lesion, or pathologic diagnosis of renal cell carcinoma (RCC). RESULTS: At 5 years, 8 of the 112 (7.1%) Bosniak IIF renal cysts underwent transformation. Of these, 3 were upgraded to Bosniak III, 1 had a complete nephrectomy at year 3, and 1 had a partial nephrectomy at year 4, both of which had benign pathology. 3 patients had surgical intervention within 8 months of follow-up and were found to have RCC. 29 of the 112 (25.9%) cysts were downgraded at some point during the five years. No patient died of RCC or developed metastatic RCC. CONCLUSIONS: This is the largest cohort of Bosniak IIF renal cysts with the longest term of follow-up in the literature to date. Our data suggests that the vast majority of IIF lesions behave benignly, and the highest risk of malignant transformation is within a year of initial diagnosis. There were no patients with local invasion, metastatic spread, or death from RCC at five years of follow-up. Source of Funding: Kaiser Permanente Community Benefit Research Grant
PD4-08 TUMOUR DETECTION BY CT (COMPUTED TOMOGRAPHY) VIRTUAL CYSTOSCOPY WITH EITHER INTRA VESICAL AIR OR DILUTE CONTRAST MEDIUM : A PROSPECTIVE COMPARATIVE STUDY Uttam Mete*, Barman Brozen, Abizer Kapadia, Anupam Lal, Niranjan Khandelwal, Nandita Kakkar, Arupkumar Mandal, Chandigarh, India INTRODUCTION AND OBJECTIVES: To study the accuracy of Computed tomography (CT) Virtual Cystoscopy after intravesical instillation of either dilute contrast medium (contrast VC) or air (Air VC) , for the detection of bladder tumour in patients undergoing conventional cystoscopy for urothelial carcinoma of urinary bladder . METHODS: 40 patients with bladder carcinoma were enrolled either in group I for air VC or in group II for contrast VC. After performing non-enhanced scan , 250 to 300 ml of dilute contrast(10 ml of 76% urogaffin contrast in 500 ml of normal saline ,2% solution) or 250-300 ml clean room air was instilled into the bladder. Helical volume scanning was performed in both supine and prone positions. Three-dimensional images were reconstructed with visualization gray scale software to study the axial images. Data was downloaded into a work station equipped with navigation software. Bladder mucosal surface was delineated using contrast medium and by adjusting the threshold HU manually using
Vol. 191, No. 4S, Supplement, Friday, May 16, 2014
CONCLUSIONS: SMART training reduces fluoroscopy times during unilateral, uncomplicated ureteroscopy for urolithiasis performed by urology residents. Source of Funding: none
PD4-06 18
THE VALUE OF F-FDG PET/CT IN STAGING OF UPPER TRACT UROTHELIAL CARCINOMA: IMPACT ON PATIENT MANAGEMENT Hajime Tanaka*, Soichiro Yoshida, Tokyo, Japan; Yoshinobu Komai, Chiba, Japan; Tatsuro Hayashi, Mizuaki Sakura, Shinji Urakami, Tokyo, Japan; Yasuyuki Sakai, Chiba, Japan; Takeshi Yuasa, Shinya Yamamoto, Hitoshi Masuda, Iwao Fukui, Junji Yonese, Yasuhisa Fujii, Kazunori Kihara, Tokyo, Japan INTRODUCTION AND OBJECTIVES: 18F-FDG PET/CT is widely used to diagnose metastases in many kinds of cancer, including bladder cancer. It may also be useful in patients with upper tract urothelial carcinoma (UTUC); however, the utility of PET/CT in the management of UTUC has not been reported. In the current study, the clinical course of patients with UTUC who underwent PET/CT was retrospectively analyzed to investigate its clinical value and impact on patient management. METHODS: Between October 2012 and September 2013, 59 consecutive patients with UTUC underwent 18F-FDG PET/CT for initial staging (n ¼ 48) or restaging (n ¼ 11) following conventional CT or MRI. The imaging findings were validated using histopathology or serial imaging, and the diagnostic accuracy of PET/CT and CT/MRI for detecting metastases were assessed and compared statistically using McNemar0 s test in both patient-based and lesion-based analyses. In addition, the clinical impact of PET/CT on patient management was analyzed by comparing questionnaires that were completed by the attending physicians before and after PET/CT. RESULTS: In the patient-based analysis, 26 (44%) of the 59 patients were diagnosed as having metastases. The sensitivity/specificity/accuracy were 96%/94%/95% in PET/CT and 81%/88%/85% in CT/MRI. The accuracy of PET/CT was significantly superior to CT/MRI (P ¼ 0.031). There were 212 lesions analyzed in 59 patients. In the lesion-based analysis, 179 (84%) of the 212 lesions were diagnosed as metastases. PET/CT had a significantly better sensitivity (77%) than CT/MRI (57%, P <0.0001). Fifty lesions (35 lymph nodes, 1 pulmonary lesion, 12 bone lesions, 1 hepatic lesion and 1 peritoneal dissemination) were detected using PET/CT but were not detected using CT/MRI, and all of these lesions were finally diagnosed as metastases. The clinical impact analysis indicated that clinicians changed their assessments of the disease extent in 21/59 (36%) patients and their treatment plans in 12/59 (20%) patients (Figure) based on the PET/CT results. CONCLUSIONS: This is the first study to show the diagnostic performance of 18F-FDG PET/CT for UTUC. The diagnostic accuracy of PET/CT for detecting metastasis is excellent. Moreover, PET/CT provides additional information compared to CT/MRI that has a beneficial impact on the patients0 clinical management.
Source of Funding: None.
e53
PD4-07 CLINICAL OUTCOMES OF BOSNIAK IIF CYSTIC RENAL LESIONS: A 5-YEAR RETROSPECTIVE STUDY Krystal Leong, Jeanne Darbinian, Oakland, CA; Jay Belani*, San Rafael, CA INTRODUCTION AND OBJECTIVES: The Bosniak renal cyst classification system is used to stratify renal cysts into their risk of malignancy. Bosniak I and II cysts are considered benign. Bosniak III and IV cysts are considered to have a high malignant potential. A Bosniak IIF renal cyst cannot clearly be categorized and needs followup imaging, but current literature offers scant data on the natural course of a IIF cyst, and there is no clear guideline on how best to follow these lesions. The objective of our study is to assess the radiologic progression and 5-year outcomes of Bosniak IIF renal lesions. METHODS: We retrospectively identified 860 patients from January 1, 2005 through December 31, 2007 who had a possible complex renal cyst on computed tomography scan (CT), magnetic resonance imaging (MRI), or ultrasound (US). All reports which contained the words “Bosniak” or “complex” and “renal cyst” were included in the study population. Cysts were verified by CT or MRI if initial imaging was an ultrasound. Patients were included in the study cohort if they were confirmed to have a Bosniak IIF cyst and had at least 5 years of follow-up data. Of the 860 eligible patients, 112 met the inclusion criteria. Over a 5 year period, each patient was evaluated for transformation, defined as progression of Bosniak category on follow-up imaging, surgical or percutaneous treatment of the lesion, or pathologic diagnosis of renal cell carcinoma (RCC). RESULTS: At 5 years, 8 of the 112 (7.1%) Bosniak IIF renal cysts underwent transformation. Of these, 3 were upgraded to Bosniak III, 1 had a complete nephrectomy at year 3, and 1 had a partial nephrectomy at year 4, both of which had benign pathology. 3 patients had surgical intervention within 8 months of follow-up and were found to have RCC. 29 of the 112 (25.9%) cysts were downgraded at some point during the five years. No patient died of RCC or developed metastatic RCC. CONCLUSIONS: This is the largest cohort of Bosniak IIF renal cysts with the longest term of follow-up in the literature to date. Our data suggests that the vast majority of IIF lesions behave benignly, and the highest risk of malignant transformation is within a year of initial diagnosis. There were no patients with local invasion, metastatic spread, or death from RCC at five years of follow-up. Source of Funding: Kaiser Permanente Community Benefit Research Grant
PD4-08 TUMOUR DETECTION BY CT (COMPUTED TOMOGRAPHY) VIRTUAL CYSTOSCOPY WITH EITHER INTRA VESICAL AIR OR DILUTE CONTRAST MEDIUM : A PROSPECTIVE COMPARATIVE STUDY Uttam Mete*, Barman Brozen, Abizer Kapadia, Anupam Lal, Niranjan Khandelwal, Nandita Kakkar, Arupkumar Mandal, Chandigarh, India INTRODUCTION AND OBJECTIVES: To study the accuracy of Computed tomography (CT) Virtual Cystoscopy after intravesical instillation of either dilute contrast medium (contrast VC) or air (Air VC) , for the detection of bladder tumour in patients undergoing conventional cystoscopy for urothelial carcinoma of urinary bladder . METHODS: 40 patients with bladder carcinoma were enrolled either in group I for air VC or in group II for contrast VC. After performing non-enhanced scan , 250 to 300 ml of dilute contrast(10 ml of 76% urogaffin contrast in 500 ml of normal saline ,2% solution) or 250-300 ml clean room air was instilled into the bladder. Helical volume scanning was performed in both supine and prone positions. Three-dimensional images were reconstructed with visualization gray scale software to study the axial images. Data was downloaded into a work station equipped with navigation software. Bladder mucosal surface was delineated using contrast medium and by adjusting the threshold HU manually using