URETEROSCOPIC BIOPSY OF UPPER TRACT UROTHELIAL CARCINOMA: IMPROVED DIAGNOSTIC ACCURACY AND HISTOPATHOLOGICAL CONSIDERATIONS USING A MULTI-BIOPSY APPROACH

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jan 2000URETEROSCOPIC BIOPSY OF UPPER TRACT UROTHELIAL CARCINOMA: IMPROVED DIAGNOSTIC ACCURACY AND HISTOPATHOLOGICAL CONSIDERATIONS USING A MULTI-BIOPSY APPROACH EDMUNDO GUARNIZO, CHRISTIAN P. PAVLOVICH, MICHAEL SEIBA, DIANE L. CARLSON, E. DARRACOTT VAUGHAN, and R. ERNEST SOSA EDMUNDO GUARNIZOEDMUNDO GUARNIZO , CHRISTIAN P. PAVLOVICHCHRISTIAN P. PAVLOVICH , MICHAEL SEIBAMICHAEL SEIBA , DIANE L. CARLSONDIANE L. CARLSON , E. DARRACOTT VAUGHANE. DARRACOTT VAUGHAN , and R. ERNEST SOSAR. ERNEST SOSA View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67970-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the diagnostic accuracy of a ureteroscopic multi-biopsy approach to upper tract urothelial carcinoma compared with subsequently resected surgical specimens. Materials and Methods: From 1990 to 1998, 45 upper tract lesions were ureteroscopically evaluated and biopsied with 3Fr cup forceps and/or an 11.5Fr resectoscope before nephroureterectomy or ureterectomy. A definitive diagnosis of urothelial carcinoma was made by biopsy in 40 lesions (89%). Each tumor was histopathologically graded but only staged if the lamina propria were uninvolved (Ta), and if the lamina propria were invaded by tumor (T1+). Results: Of the 40 urothelial tumors 16 (40%) were in the renal pelvis, and 8 (20%) in the proximal and 16 (40%) in the distal ureter. Of the lesions 95% were papillary and 65% were grade 2. Ureteroscopic biopsy grade matched surgical pathological grade in 31 of the 40 cases (78%), and was less than surgical pathological grade in the remainder. Lamina propria was detected in 27 of the 40 biopsies, including 21 of the 34 cup (62%) and all 6 resection loop (100%) biopsies. Ureteroscopic biopsy staging in 27 cases revealed Ta and T1+ disease in 22 and 5, respectively. In the 5 cases in which ureteroscopic biopsy stage was T1+ surgical pathological stage was also pT1+ (range pT1 to pT3). Tumors were pathologically up staged to pT1+ (range pT1 to pT3) in 10 of the 22 cases (45%) in which ureteroscopic biopsy stage was Ta. Tumor location did not affect diagnostic accuracy. Conclusions: This multi-biopsy ureteroscopic approach provided the tissue diagnosis of urothelial carcinoma in 89% of cases and predicted exact histopathological grade in 78%. Although it is not accurate as a staging modality, multi-biopsy ureteroscopy may assess lamina propria invasion in two-thirds of cases. References 1 : Surgical management of upper tract transitional cell carcinoma. In: . Baltimore: Williams & Wilkins1996: 397. chapt. 25B. Google Scholar 2 : Renal pelvic tumors. JAMA1971; 218: 845. Google Scholar 3 : Prognostic factors in carcinoma of the ureter. J Urol1981; 125: 632. Link, Google Scholar 4 : Systematic mapping of nephroureterectomy specimens removed for urothelial cancer: pathological findings and clinical correlations. J Urol1982; 128: 243. Link, Google Scholar 5 : Ureteropyeloscopy in the evaluation of upper tract filling defects. J Urol1986; 136: 383. Link, Google Scholar 6 : Impact of endourology on diagnosis and management of upper urinary tract urothelial cancer. J Urol1989; 141: 1298. Link, Google Scholar 7 : Cytologic diagnosis of upper urinary tract neoplasms by ureteroscopic sampling. Acta Cytol1995; 39: 733. Google Scholar 8 : Upper urinary tract filling defects: flexible ureteroscopic diagnosis. J Urol1990; 143: 1196. Link, Google Scholar 9 : Ureteroscopic biopsy in the upper urinary tract. Urology1994; 44: 451. Google Scholar 10 : Upper-tract transitional cell carcinoma. Urology1997; 50: 321. Crossref, Medline, Google Scholar 11 : Ureteroscopic cytologic diagnosis of upper tract lesions. J Endourol1993; 7: 311. Google Scholar 12 : Endoscopic management of upper tract urothelial tumors. Tech Urol1997; 3: 152. Google Scholar 13 : Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol1997; 157: 33. Link, Google Scholar 14 : Endoscopic brush cytology of the upper urinary tract. Evaluation of its efficacy and potential limitations in diagnosis. Acta Cytol1997; 41: 377. Google Scholar 15 : Renal brush biopsy: survey of indications, techniques and results. J Urol1981; 126: 146. Link, Google Scholar 16 : Lavage cytology of the renal pelvis and ureter with special reference to tumors. J Urol1980; 124: 597. Link, Google Scholar 17 : Limitations of ureteroscopy in diagnosis of invasive upper tract urothelial cancer. Urol Int1996; 56: 13. Google Scholar 18 : Management of upper tract transitional cell carcinoma. In: . New York: W. B. Saunders Co.1995: 44. chapt. 4. Google Scholar 19 : Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol1997; 157: 1560. Link, Google Scholar From the James Buchanan Brady Foundation, Departments of Urology and Pathology, New York Presbyterian Hospital–Cornell Medical Center, New York, New York© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byMargolin E, Matulay J, Li G, Meng X, Chao B, Vijay V, Silver H, Clinton T, Krabbe L, Woldu S, Singla N, Bagrodia A, Margulis V, Huang W, Bjurlin M, Shah O and Anderson C (2018) Discordance between Ureteroscopic Biopsy and Final Pathology for Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 199, NO. 6, (1440-1445), Online publication date: 1-Jun-2018.Ordon M, Perlis N and Landman J (2014) Endoscopic Management of Upper Tract Transitional Cell CarcinomaUrology Practice, VOL. 1, NO. 1, (22-26), Online publication date: 1-May-2014.Brien J, Shariat S, Herman M, Ng C, Scherr D, Scoll B, Uzzo R, Wille M, Eggener S, Terrell J, Lucas S, Lotan Y, Boorjian S and Raman J (2010) Preoperative Hydronephrosis, Ureteroscopic Biopsy Grade and Urinary Cytology Can Improve Prediction of Advanced Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 184, NO. 1, (69-73), Online publication date: 1-Jul-2010. Volume 163Issue 1January 2000Page: 52-55 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.KeywordsbiopsyureteroscopycarcinomaurotheliumureterMetricsAuthor Information EDMUNDO GUARNIZO More articles by this author CHRISTIAN P. PAVLOVICH More articles by this author MICHAEL SEIBA More articles by this author DIANE L. CARLSON More articles by this author E. DARRACOTT VAUGHAN More articles by this author R. ERNEST SOSA More articles by this author Expand All Advertisement PDF downloadLoading ...