The spread of a pelvic tumor to the ureter is an important criterion determining surgical treatment tactics.
OBJECTIVE: to evaluate the possibility of radiology methods in assessing the invasion of the ureter wall at pelvic tumors with its involvement.
MATERIALS AND METHODS: Ureteral diseases are rarely detected. In four clinical centers in Russia (Moscow, St. Petersburg, Grozny, Krasnogorsk) in the period 2014-2018 47 patients with such lesion revealed. Of these, 19 (40.4%) cases were diagnosed with tumors originating from other organs involving the ureter. All patients underwent ultrasound, MSCT and MRI and were operated on with morphological verification: uterus cancer - 6 (31.5%) cases, metastasizing uterine leiomyoma - 1 (5.3%), neurofibromatosis of the trunk subcutaneous tissue, limbs, retroperitoneal space and small pelvis - 1 5.3%), ovarian cancer - 1 (5.3%), prostate cancer - 1 (5.3%), rectal cancer - 1 (5.3%), rhabdomyosarcoma (primary and recurrent) - 1 (5.3%), lymphoma - 2 (10.4%), urothelial bladder cancer with spread to the ureter - 4 (21.0%).
RESULTS: Ultrasound, MSCT and MRI do not allow us to individually convincingly verify the involvement of the ureter wall in the pathological process in pelvic tumors involving the ureter. As a result, it was decided to retrospectively evaluate the involvement of the ureter in the pathological process when compared with intraoperative data and the results of a morphological study.
According to the survey, the patients were divided into three groups, depending on the volume of tumor contact with the ureter circumference:
group 1 (6 (31.6%) patients) - <25%;
group 2 (8 (42.1%) patients) - 25-75%;
group 3 (5 (26.3%) patients) - >75%.
Then the probability of invasion of the ureter wall was calculated by groups: tumor and vessel contact 0-25% - 10.5%; 25-75% - 31.5%; 75-100% - 57.8%. Thus, group 2 proved to be the most difficult in assessing the invasion of the ureter wall, there was a larger number of patients with a false-positive and false-negative diagnosis.
CONCLUSION: The volume of ureteral lesion along the circumference may be a more objective criterion of differential diagnosis of such involvement. In group 1 (<25% of the circumference), no invasion of the ureter wall was detected in 89.5% of the observations. In group 2 (25-75% of the circumference), the invasion of the ureter wall was detected in every third patient (31.5%). In group 3 (>75% of the circumference), the invasion of the ureter wall was detected in 57.8% of patients.
