URETEROSCOPIC CYTOLOGIC DIAGNOSIS OF UPPER TRACT LESIONS

The definitive diagnosis of upper urinary tract lesions often relies o n providing adequate tissue samples for cytopathologic review. Uretero pyeloscopy allows direct examination of these lesions and enables tiss ue sampling under visual control. A retrospective analysis of 11 patie nts with 13 abnormal upper tracts was performed, comparing sampling te chniques performed under endoscopic vision (brush biopsy, fine-needle aspiration [FNA], and forceps biopsy) with standard retrograde cathete r lavage. Forceps biopsy was the most accurate of the direct vision sa mpling methods (100%), although it provided adequate tissue only 56% o f the time. Direct vision brush biopsy and FNA were better than forcep s biopsy at providing adequate tissue but were less accurate, at 83% a nd 89%, respectively. Surprisingly, retrograde catheter lavage was sup erior to direct vision sampling methods. These results may be attribut able to patient selection bias in that five of seven upper tracts foun d to have malignancy had multifocal disease. One patient developed a d istal ureteral stricture from instrumentation that was managed success fully with an endoureterotomy.