PURPOSE: Urachal carcinomas are rare urologic neoplasms that arise along the urachal remnant from the umbilicus to the dome of the bladder.
No published study has examined the diagnostic accuracy of modern preoperative testing to differentiate urachal carcinoma from a benign urachal cyst and spare resection of potentially benign urachal tissue. Our objective was to determine if a urachal mass can be safely diagnosed preoperatively.
MATERIALS AND METHODS: 104 patients with a urachal mass treated between 1979 and 2011. Exclusion criteria were unresectable metastatic disease at presentation, patients that did not undergo surgery, and management by transurethral resection alone. Of the patients that remained, only 65 had both preoperative diagnostic testing and definitive pathologic results available for analysis. Mean age was 51 years, 86% were Caucasian and 65% were male. Accuracy of diagnosis based on preoperative tests was compared to final pathology (cancer or benign).
RESULTS: Fifty-seven tumors (87%) were malignant and the majority of masses (83%) were adenocarcinoma. Compared to computed tomography, cytology, and exploration under anesthesia, transurethral resection of the bladder tumor has the highest sensitivity (0.93), specificity (1), and positive predictive value (1), but a low negative predictive value (0.5). Limitations included small cohort size and few benign urachal masses for comparison.
CONCLUSIONS: No test has a high enough negative predictive value to prevent excision of a urachal mass. With few treatment options for localized, advanced, and metastatic urachal cancer, these data suggest that early excision remains the best treatment for a suspicious urachal mass.
Written by:
Meeks JJ, Herr HW, Bernstein M, Al-Ahmadie HA, Dalbagni G. Are you the author?
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.
Reference: J Urol. 2012 Oct 19. pii: S0022-5347(12)05271-8.
doi: 10.1016/j.juro.2012.10.043
PubMed Abstract
PMID: 23089466
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