Endoluminal Ultrasound for Upper Tract Urothelial Carcinoma

  • Scott G. Hubosky
  • Raghu Vikram
  • Surena F. MatinEmail author


Accurate clinical staging of UTUC remains elusive, and relies heavily on ureteroscopic biopsy grade and other findings as surrogates for predicting final pathologic stage. Endoluminal ultrasound (ELUS) has been used in vascular and nonvascular applications dating back almost 40 years. For the upper tract a small experience has been building. ELUS of the upper tract visualizes primarily the muscularis layer of the ureter, which is seen as a hypoechoic symmetric rim, with the periureteral fat seen beyond it, visualized as a very bright hyperechoic layer. UTUC tumors are seen as hypoechoic masses that are either intraluminal or cause bulging of the collecting system. Invasive disease is suspected when an irregular hypoechoic mass extends into or beyond the muscularis layer and disrupts the hyperechoic layer of periureteral fat. Several limitations remain with ELUS, including probe size and inability to direct the transducer into the mid- or lower calyces. However, a few small, retrospective, single center experiences with small numbers of patients have shown the potential for this modality to improve clinical staging. Any modality that may help better stratify patients to endoscopic management, nephroureterectomy alone, or initial neoadjuvant chemotherapy, deserves further study. Larger multi-institutional efforts will be needed to acquire the data to further characterize the benefits of ELUS for staging of UTUC.


Ureter Ureteral cancer Urothelial cancer Renal pelvis Ultrasound Kidney cancer Staging 


  1. 1.
    Hall MC, Womack S, Sagalowsky AI, et al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998;52:594–601.CrossRefPubMedGoogle Scholar
  2. 2.
    Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer. 2009;115:1224–33.CrossRefPubMedGoogle Scholar
  3. 3.
    Matin SF, Margulis V, Kamat A, et al. Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer. 2010;116:3127–34.CrossRefPubMedGoogle Scholar
  4. 4.
    Porten S, Siefker-Radtke MD, Xiao L, et al. Neoadjuvant chemotherapy improves survival of patients with upper tract urothelial carcinoma. Cancer. 2014;120:1794–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kaag MG, O’Malley RL, O’Malley P, et al. Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Euro Urol. 2010;58:581–7.CrossRefGoogle Scholar
  6. 6.
    Grasso M, Fishman AI, Cohen J, et al. Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: a 15-year comprehensive review of 160 consecutive patients. BJUI. 2012;110:1618–26.CrossRefGoogle Scholar
  7. 7.
    Cutress ML, Stewart GD, Wells-Cole S, et al. Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience. BJUI. 2012;110:1608–17.CrossRefGoogle Scholar
  8. 8.
    Keeley FX, Kulp DA, Bibbo M, McCue PA, Bagley DH. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol. 1997;157:33–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Brown GA, Matin SF, Busby JE, et al. Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: implications for therapy. Urology. 2007;70(2):252–6.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Scolieri MJ, Paik ML, Brown SL, et al. Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinoma. Urology. 2000;56:930–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Planz B, George R, Adam G, et al. Computed tomography for detection and staging of transitional cell carcinoma of the upper urinary tract. Euro Urol. 1995;27:146–50.CrossRefGoogle Scholar
  12. 12.
    Favaretto RL, Shariat SF, Savage C, et al. Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle-invasive and non-organ confined disease in patients with upper tract urothelial carcinoma. BJUI. 2011;109:77–82.CrossRefGoogle Scholar
  13. 13.
    Fukuda M, Hirata K, Saito K, et al. On the diagnostic use of echoendoscope in abdominal diseases: diagnostic experiences with a new type of echoendoscope in abdominal diseases. Proc Jpn J Med Ultrasound. 1980;37:409–10.Google Scholar
  14. 14.
    Goldberg BB, Bagley DH, Liu JB, et al. Endoluminal sonography of the urinary tract: preliminary observations. AJR. 1991;156:99–103.CrossRefPubMedGoogle Scholar
  15. 15.
    Johnson GB, Portela D, Grasso M. Advanced ureteroscopy: wireless and sheathless. J Endourol. 2006;20:552–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Matin SF, Kamat AM, Grossman HB. High-frequency endoluminal ultrasonography as an aid to the staging of upper tract urothelial carcinoma. J Ultrasound Med. 2010;29:1277–84.CrossRefPubMedGoogle Scholar
  17. 17.
    Liu JB, Bagley DH, Conlin MJ, et al. Endoluminal sonographic evaluation of ureteral and renal pelvic neoplasms. J Ultrasound Med. 1997;16:515–21.CrossRefPubMedGoogle Scholar
  18. 18.
    Brown GA, Busby JE, Wood CG, et al. Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: time to change the treatment paradigm? BJUI. 2006;98:1176–80.CrossRefGoogle Scholar
  19. 19.
    Hubosky SG, Healy KA, Grasso M, et al. Accessing the difficult ureter and the importance of ureteroscope miniaturization: history is repeating itself. Urology. 2014;84(4):740–2.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Scott G. Hubosky
    • 1
  • Raghu Vikram
    • 2
  • Surena F. Matin
    • 3
    Email author
  1. 1.Department of UrologySidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Department of Diagnostic RadiologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of UrologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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