DIAGNOSTIC-ACCURACY OF URETEROSCOPIC BIOPSY IN UPPER TRACT TRANSITIONAL-CELL CARCINOMA

Purpose: Our aim was to determine the accuracy of ureteroscopic biopsi es and cytological techniques compared to open surgical specimens of u pper tract transitional cell carcinoma. Materials and Methods: From 19 85 to 1995, 51 cases of upper tract transitional cell carcinoma were d iagnosed ureteroscopically and distal ureterectomy or nephroureterecto my was performed. Each patient underwent direct ureteroscopic inspecti on and biopsy. Fresh samples were delivered to the cytopathology labor atory, where they were examined using cytospin and smear. A cell block was prepared when visible tissue was present. Grades of ureteroscopic biopsies were compared to grades and stages of surgical specimens in 42 cases. Results: Cytological evaluation was positive for malignancy in 48 of the 51 cases (94.1%). Grading of ureteroscopic specimens was possible in 42 cases (82.4%). Transitional cell carcinoma grade on ure teroscopy accurately predicted tumor grade and stage in the surgical s pecimens. Of 30 low or moderate grade ureteroscopic specimens 27 (90%) proved to be low or moderate grade transitional cell carcinoma in the surgical specimens, while 11 of the 12 high grade ureteroscopic speci mens (91.6%) proved to be high grade transitional cell carcinoma (p < 0.0001). Of 30 low or moderate grade ureteroscopic specimens 26 (86.6% ) had a low stage (Ta or T1) tumor. In contrast, 8 of 12 high grade ur eteroscopic specimens (66.7%) had invasive tumor (stage T2 or T3) in t he surgical specimen (p = 0.0006). Conclusions: Ureteroscopic inspecti on and biopsy combined with cytological techniques provide accurate in formation regarding grade and stage of upper tract transitional cell c arcinoma.