{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:47:56Z","timestamp":1791953276176,"version":"4.3.4"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"abstract":"\n Objectives<\/jats:title>\n \n To evaluate the incremental clinical value of [\n 18<\/jats:sup>\n F]fluorodeoxyglucose positron emission tomography\/computed tomography ([\n 18<\/jats:sup>\n F]FDG\u2010PET\/CT) beyond contrast\u2010enhanced computed tomography (CECT) for primary staging of suspected high\u2010risk upper tract urothelial carcinoma (UTUC).\n <\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n \n We conducted a consecutive paired\u2010imaging cohort study of patients with suspected high\u2010risk UTUC undergoing primary staging with both CECT and [\n 18<\/jats:sup>\n F]FDG\u2010PET\/CT at a tertiary cancer centre between 2013 and 2025. The primary outcome was clinically relevant stage migration, defined as a transition between non\u2010metastatic and metastatic disease, and its impact on multidisciplinary treatment recommendation. Secondary outcomes included diagnostic performance in cases with histopathological verification.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 203 patients, [\n 18<\/jats:sup>\n F]FDG\u2010PET\/CT resulted in stage migration in 45 (22%), predominantly through upstaging (39 patients [19%]), comprising regional nodal upstaging in 19 patients (9.4%) and distant metastatic upstaging in 22 (11%), with both occurring in two patients. [\n 18<\/jats:sup>\n F]FDG\u2010PET\/CT led to treatment modification in 43 patients (21%). Stage migration was more frequent in the presence of CECT\u2010suspicious lymph nodes (odds ratio 3.4, 95% confidence interval 1.6\u20137.3). Among the 62 patients with histopathological verification, [\n 18<\/jats:sup>\n F]FDG\u2010PET\/CT demonstrated significantly higher sensitivity for nodal metastases than CECT (74% vs 33%) with similar specificity (89% vs 86%). Limitations include the retrospective single\u2010centre design and incomplete pathological confirmation, mostly due to neoadjuvant treatment and omission of surgery in metastatic disease.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n [\n 18<\/jats:sup>\n F]FDG\u2010PET\/CT provides actionable staging information beyond CECT in high\u2010risk UTUC, leading to treatment modification in one in five patients and in half of those with CECT\u2010suspicious nodal disease. These findings support selective use of [\n 18<\/jats:sup>\n F]FDG\u2010PET\/CT in primary staging to refine treatment selection.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.70483","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:13:56Z","timestamp":1791951236000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["[\n \n 18<\/sup>\n F]\n <\/scp>\n fluorodeoxyglucose PET\/CT refines staging and treatment selection in high\u2010risk upper tract urothelial carcinoma"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4602-979X","authenticated-orcid":false,"given":"Renee A. G.","family":"Lijnen","sequence":"first","affiliation":[{"name":"Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1737-1522","authenticated-orcid":false,"given":"Joanneke B.","family":"Ringia","sequence":"additional","affiliation":[{"name":"Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kees","family":"Hendricksen","sequence":"additional","affiliation":[{"name":"Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4992-8024","authenticated-orcid":false,"given":"Wouter V.","family":"Vogel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Netherlands Cancer Institute, Hospital Amsterdam The Netherlands"},{"name":"Department of Nuclear Medicine Netherlands Cancer Institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry N.","family":"Boellaard","sequence":"additional","affiliation":[{"name":"Department of Radiology Netherlands Cancer Institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel S.","family":"van der Heijden","sequence":"additional","affiliation":[{"name":"Department of Oncology Netherlands Cancer Institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8824-8697","authenticated-orcid":false,"given":"Arthur J. A. T.","family":"Braat","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Netherlands Cancer Institute Amsterdam The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine UMC Utrecht Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas W. G.","family":"van Rhijn","sequence":"additional","affiliation":[{"name":"Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands"},{"name":"Department of Urology Leiden University Medical Center Leiden The Netherlands"},{"name":"Department of Urology Caritas St Josef Medical Centre, University of Regensburg Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3317-6427","authenticated-orcid":false,"given":"Laura S.","family":"Mertens","sequence":"additional","affiliation":[{"name":"Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s00345-016-1928-x","article-title":"Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper\u2010tract urothelial carcinoma (UTUC)","volume":"35","author":"Soria F","year":"2017","journal-title":"World J Urol"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"3385","DOI":"10.1007\/s00345-020-03576-3","article-title":"Higher than expected and significantly increasing incidence of upper tract urothelial carcinoma. A population based study","volume":"39","author":"Almas B","year":"2021","journal-title":"World J Urol"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.eururo.2012.02.018","article-title":"Stage\u2010specific impact of tumor location on oncologic outcomes in patients with upper and lower tract urothelial carcinoma following radical surgery","volume":"62","author":"Rink M","year":"2012","journal-title":"Eur Urol"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.urolonc.2020.09.029","article-title":"Site of metastatic recurrence impacts prognosis in patients with high\u2010grade upper tract urothelial carcinoma","volume":"39","author":"Cheaib JG","year":"2021","journal-title":"Urol Oncol"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/JU.0000000000003085","article-title":"Diagnostic accuracy of clinical lymph node staging for upper tract urothelial cancer patients: a multicenter, retrospective, observational study","volume":"209","author":"Pallauf M","year":"2023","journal-title":"J Urol"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.euf.2017.09.015","article-title":"Potential benefit of lymph node dissection during radical Nephroureterectomy for upper tract urothelial carcinoma: a systematic review by the European Association of Urology guidelines panel on non\u2010muscle\u2010invasive bladder cancer","volume":"5","author":"Dominguez\u2010Escrig JL","year":"2019","journal-title":"Eur Urol Focus"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/S0140-6736(20)30415-3","article-title":"Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open\u2010label, randomised controlled trial","volume":"395","author":"Birtle A","year":"2020","journal-title":"Lancet"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.eururo.2020.07.003","article-title":"Neoadjuvant and adjuvant chemotherapy for upper tract urothelial carcinoma: a 2020 systematic review and meta\u2010analysis, and future perspectives on systemic therapy","volume":"79","author":"Leow JJ","year":"2021","journal-title":"Eur Urol"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1002\/cncr.25050","article-title":"Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high\u2010risk upper tract transitional cell carcinoma","volume":"116","author":"Matin SF","year":"2010","journal-title":"Cancer"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s00345-019-02875-8","article-title":"Diagnostic performance of multidetector computed tomographic (MDCTU) in upper tract urothelial carcinoma (UTUC): a systematic review and meta\u2010analysis","volume":"38","author":"Janisch F","year":"2020","journal-title":"World J Urol"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/bju.16091","article-title":"Staging fluorodeoxyglucose positron emission tomography\/computed tomography for muscle\u2010invasive bladder cancer: a nationwide population\u2010based study","volume":"132","author":"Richters A","year":"2023","journal-title":"BJU Int"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.euo.2021.01.005","article-title":"Staging (18)F\u2010fluorodeoxyglucose positron emission tomography\/computed tomography changes treatment recommendation in invasive bladder cancer","volume":"5","author":"Voskuilen CS","year":"2022","journal-title":"Eur Urol Oncol"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.euo.2019.09.004","article-title":"Diagnostic value of (18)F\u2010fluorodeoxyglucose positron emission tomography with computed tomography for lymph node staging in patients with upper tract urothelial carcinoma","volume":"3","author":"Voskuilen CS","year":"2020","journal-title":"Eur Urol Oncol"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1159\/000381269","article-title":"Clinical value of 18F\u2010Fluorodeoxyglucose positron emission tomography\/computed tomography in upper tract urothelial carcinoma: impact on detection of metastases and patient management","volume":"96","author":"Tanaka H","year":"2016","journal-title":"Urol Int"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.eururo.2025.02.023","article-title":"European Association of Urology guidelines on upper urinary tract urothelial carcinoma: summary of the 2025 update","volume":"87","author":"Masson\u2010Lecomte A","year":"2025","journal-title":"Eur Urol"},{"key":"e_1_2_10_17_1","first-page":"183","volume-title":"TNM Classification of Malignant Tumours","author":"Tumours U","year":"2025"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.clgc.2021.10.002","article-title":"Discordance between clinical and pathological staging and grading in upper tract urothelial carcinoma","volume":"20","author":"Mori K","year":"2022","journal-title":"Clin Genitourin Cancer"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1007\/s10147-015-0817-4","article-title":"Fluorodeoxyglucose positron emission tomography\/computed tomography for diagnosis of upper urinary tract urothelial carcinoma","volume":"20","author":"Asai S","year":"2015","journal-title":"Int J Clin Oncol"},{"key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/MOU.0000000000001097","article-title":"Need for and extent of lymph node dissection for upper tract urothelial carcinoma: an updated review in 2023","volume":"33","author":"Yanagisawa T","year":"2023","journal-title":"Curr Opin Urol"},{"key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.urolonc.2021.07.029","article-title":"Does neoadjuvant chemotherapy have therapeutic benefit for node\u2010positive upper tract urothelial carcinoma? Results of a multi\u2010center cohort study","volume":"40","author":"Shigeta K","year":"2022","journal-title":"Urol Oncol"},{"key":"e_1_2_10_22_1","doi-asserted-by":"crossref","DOI":"10.1007\/s00345-024-05267-9","article-title":"Role of neoadjuvant chemotherapy in patients with locally advanced and clinically positive nodes upper tract urothelial carcinoma treated with Nephroureterectomy: real\u2010world data from the ROBUUST 2.0 registry","volume":"42","author":"Tuderti G","year":"2024","journal-title":"World J Urol"},{"key":"e_1_2_10_23_1","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.euo.2024.12.009","article-title":"Benefit and harms of radical Nephroureterectomy as part of a multimodal treatment strategy for upper tract urothelial carcinoma patients presenting with clinical evidence of regional lymph node metastasis: a systematic review and meta\u2010analysis by the European Association of Urology guidelines","volume":"8","author":"Rai BP","year":"2025","journal-title":"Eur Urol Oncol"},{"key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.ejrad.2015.12.017","article-title":"FDG\u2010PET\/CT as a post\u2010treatment restaging tool in urothelial carcinoma: comparison with contrast\u2010enhanced CT","volume":"85","author":"Kitajima K","year":"2016","journal-title":"Eur J Radiol"},{"key":"e_1_2_10_25_1","doi-asserted-by":"crossref","DOI":"10.3390\/cancers17020232","article-title":"Nuclear medicine and molecular imaging in urothelial cancer: current status and future directions","volume":"17","author":"McDonald S","year":"2025","journal-title":"Cancers (Basel)"},{"key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.eururo.2022.09.017","article-title":"Positron emission tomography\/computed tomography for staging of bladder cancer: a continuing clinical controversy","volume":"83","author":"Mertens LS","year":"2023","journal-title":"Eur Urol"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70483","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bju.70483","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70483","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:14:00Z","timestamp":1791951240000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/bju.70483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":25,"alternative-id":["10.1111\/bju.70483"],"URL":"https:\/\/doi.org\/10.1111\/bju.70483","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"2026-10-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"bju.70483"}}