Diagnostic Accuracy of Clinical Lymph Node Staging for Upper Tract Urothelial Cancer Patients: A Multicenter, Retrospective, Observational Study

Maximilian Pallauf, David D'Andrea, Frederik König, Ekaterina Laukhtina, Takafumi Yanagisawa, Morgan Rouprêt, Siamak Daneshmand, Hooman Djaladat, Alireza Ghoreifi, Francesco Soria, Kazutoshi Fujita, Stephen A. Boorjian, Aaron M. Potretzke, Andrea Mari, Mathieu Roumiguié, Alessandro Antonelli, Alberto Bianchi, Zine Eddine Khene, John P. Sfakianos, Marcus JamilJoost L. Boormans, Jay D. Raman, Nico C. Grossmann, Alberto Breda, Axel Heidenreich, Francesco Del Giudice, Nirmish Singla, Shahrokh F. Shariat, Benjamin Pradere

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose:Treatment options for the management of upper tract urothelial cancer are based on accurate staging. However, the performance of conventional cross-sectional imaging for clinical lymph node staging (N-staging) remains poorly investigated. This study aims to evaluate the diagnostic accuracy of conventional cross-sectional imaging for upper tract urothelial cancer N-staging.Materials and Methods:This study was a multicenter, retrospective, observational study. We included 865 nonmetastatic (M0) upper tract urothelial cancer patients treated with curative intended surgery and lymph node dissection who had been staged with conventional cross-sectional imaging before surgery. We compared clinical (c) and pathological (p) N-staging results to evaluate the concordance of node-positive (N+) and node-negative (N0) disease and calculate cN-staging's diagnostic accuracy.Results:Conventional cross-sectional imaging categorized 750 patients cN0 and 115 cN+. Lymph node dissection categorized 641 patients pN0 and 224 pN+. The cN-stage was pathologically downstaged in 6.8% of patients, upstaged in 19%, and found concordant in 74%. The sensitivity and specificity of cN-staging were 25% (95% CI 20; 31) and 91% (95% CI 88; 93). Positive and negative likelihood ratios were 2.7 (95% CI 2.0; 3.8) and 0.83 (95% CI 0.76; 0.89). The area under the receiver operating characteristics curve (0.58, 95% CI 0.55; 0.61) revealed low diagnostic accuracy.Conclusions:Conventional cross-sectional imaging had low sensitivity in detecting upper tract urothelial cancer pN+ disease. However, cN+ increased the likelihood of pN+ by almost threefold. Thus, conventional cross-sectional imaging is a rule-in but not a rule-out test. Lymph node dissection should remain the standard during extirpative upper tract urothelial cancer surgery to obtain accurate N-staging. cN+ could be a strong argument for early systemic treatment.

Original languageEnglish (US)
Pages (from-to)515-524
Number of pages10
JournalJournal of Urology
Issue number3
StatePublished - Mar 1 2023

All Science Journal Classification (ASJC) codes

  • Urology

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