Ureteroscopic biopsy of upper tract urothelial carcinoma: Improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach
E. Guarnizo et al., Ureteroscopic biopsy of upper tract urothelial carcinoma: Improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach, J UROL, 163(1), 2000, pp. 52-55
Purpose: We assessed the diagnostic accuracy of a ureteroscopic multi-biops
y approach to upper tract urothelial carcinoma compared with subsequently r
esected surgical specimens.
Materials and Methods: From 1990 to 1998, 45 upper tract lesions were urete
roscopically evaluated and biopsied with 3Fr cup forceps and/or an 11.5Fr r
esectoscope before nephroureterectomy or ureterectomy. A definitive diagnos
is of urothelial carcinoma was made by biopsy in 40 lesions (89%). Each tum
or was histopathologically graded but only staged if the lamina propria wer
e 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 resect
ion 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 uret
eroscopic biopsy stage was T1+ surgical pathological stage was also pT1+ (r
ange pT1 to pT3). Tumors were pathologically up staged to pT1+ (range pT1 t
o 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 d
iagnosis of urothelial carcinoma in 89% of cases and predicted exact histop
athological grade in 78%. Although it is not accurate as a staging modality
, multi-biopsy ureteroscopy may assess lamina propria invasion in two-third
s of cases.