Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper tract urothelial carcinoma

Abstract

PurposeTo summarize knowledge on upper urinary tract carcinoma (UTUC) regarding diagnostic procedures, risk factors and prognostic markers.MethodsA scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC in Stockholm, September 2018.ResultsTumor stage and grade are the most important prognostic factors. CT urography (CTU) including corticomedullary phase is the preferred imaging modality. A clear tumor on CTU in combination with high-grade UTUC in urine cytology identifies high-risk UTUC, and in some cases indirect staging can be obtained. Bladder urine cytology has limited sensitivity, and in most cases ureterorenoscopy (URS) with in situ samples for cytology and histopathology are mandatory for exact diagnosis. Image-enhancing techniques, Image S1 and narrow-band imaging, may improve tumor detection at URS. Direct confocal laser endomicroscopy may help to define grade during URS. There is strong correlation between stage and grade, accordingly correct grading is crucial. The correlation is more pronounced using the 1999 WHO than the 2004 classification: however, the 1999 system risks greater interobserver variability. Using both systems is advisable. A number of tissue-based molecular markers have been studied. None has proven ready for use in clinical practice.ConclusionsCorrect grading and staging of UTUC are mandatory for adequate treatment decisions. Optimal diagnostic workup should include CTU with corticomedullary phase, URS with in situ cytology and biopsies. Both WHO classification systems (1999 and 2004) should be used to decrease risk of undergrading or overtreatment.

Discordance Between Clinical and Pathological Staging and Grading in Upper Tract Urothelial Carcinoma

“…With the development of conservative endoscopic treatment and the implementation of neoadjuvant chemotherapy for patients with UTUC, ureteroscopic (URS) biopsy has gained importance in the diagnosis, follow-up, and treatment decision-making. URS biopsy has been described as the most accurate predictor of the pathological stage and grade of surgical specimens 11,12 . The European Association of Urology (EAU) UTUC guidelines recommend the consideration of URS biopsy when additional information is likely to affect treatment decisions 1 .…”

The Clinical Value of Multislice Spiral Computed Tomography in the Diagnosis of Upper Digestive Tract Diseases

“…Simulation of the gastrointestinal lumen is based on a predetermined threshold value, and the structures within the threshold value are formed into a simulated three-dimensional reconstruction image, whose image resembles a barium-filled image [ 20 ]. The advantage is that the image is three-dimensional and intuitive, which can show the shape and contour of the organ, and the anatomical relationship is clear, which is conducive to the localization of the lesion [ 21 ]. The disadvantages are that only one threshold can be selected, and changes in the threshold value can cause false positives or false negatives, cannot show the density of the actual tissue, and cannot observe the intricacy structures.…”

The accuracy of computed tomography in the diagnosis of upper urinary tract urothelial carcinoma in correlation with the final histopathology

“…Bladder urine cytology has limited sensitivity, and in most cases, ureterorenoscopy (URS) with in situ samples for cytology and histopathology are mandatory for an exact diagnosis. [ 14 ]…”