CT urogram of a 60-year-old male with painless haematuria shows an enhancing soft tissue mass in the left renal pelvis causing hydronephrosis, and filling defect in the ureter. The most important differential investigation to guide management is:

• A 18F-FDG PET-CT for distant staging
• B Retrograde pyelography and ureteroscopy with biopsy ✓
• C Urine cytology alone is adequate for diagnosis
• D Renal angiography to assess vascularity

Explanation

For suspected upper tract urothelial carcinoma (UTUC), retrograde pyelography provides better mucosal detail than CT urogram for defining the extent of urothelial lesion. Ureteroscopy allows direct visualisation and biopsy for tissue diagnosis and grade, which guides the choice between nephro-ureterectomy (standard) vs. endoscopic management for low-grade tumours. FDG PET has limited sensitivity for UTUC. Urine cytology has poor sensitivity (~35%) for low-grade UTUC. Angiography is not indicated.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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