Diagnostic Accuracy of Qualitative and Quantitative Computed Tomography Analysis for Diagnosis of Pathological Grade and Stage in Upper Tract Urothelial Cell Carcinoma

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 χ 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; κ = 0.45). Tumors characterized as spiculated/irregular margin ( P = 0.003; 0.30) and heterogeneous ( P < 0.001; κ = 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.