Evaluation of the Ureter Wall Invasion for Pelvic Tumors with Its Involvement according to Radiology Methods

Yulia Stepanova 1 Saikhan Dunaev 2,3 Aleksandr Vasiliev 4
1Radiology, A.V. Vishnevsky National Medical Research Center of Surgery, Russia
2Radiology, Republican Oncology Center, Russia
3Radiology, Chechen State University, Russia
4Radiology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Russia

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.

Yulia Stepanova
Yulia Stepanova