Diagnostic Accuracy of Ureteroscopic Biopsy in Upper Tract Transitional Cell Carcinoma

Keeley, Francis X.; Kulp, Deborah A.; Bibbo, Marluce; McCue, Peter A.; Bagley, Demetrius H.

doi:10.1016/s0022-5347(01)65273-x

Cited by 252 publications

(121 citation statements)

References 21 publications

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“…In clinical studies, ureteroscopy is particularly helpful in suspected lesions and might be useful in establishing the UTUC pathological diagnosis [25, 26], even though under-grading may occur from the diagnostic biopsy [27]. IVR is a commonly observed oncologic event occurring in approximately a half of UTUC patients following RNU.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

et al. 2017

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Objective: To assess the impact of diagnostic ureteroscopy (URS) prior to radical nephroureterectomy (RNU) on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). Materials and Methods: A systematic literature search of the Medline, Embase, PubMed, and Cochrane library was performed in August 2017. Cumulative analyses of available hazard ratios (HRs) and their 95% CI were conducted using Stata version 12.0. Results: Eleven studies including 4,057 participants were included, with a total of 1,403 patients diagnosed with IVR during the follow-up period. The pooled HRs of eight studies suggested that diagnostic URS prior to RNU significantly increased the IVR risk after RNU (HR 1.53, 95% CI 1.31–1.77; p < 0.001). However, the preoperative diagnostic URS was not associated with cancer-specific survival (HR 0.72; p = 0.11), metastasis-free survival (HR 1.09; p = 0.60) or overall survival (HR 1.12; p = 0.73). No publication bias was observed (Begg, p = 0.90; Egger, p = 0.71). Conclusions: Regardless, the diagnostic URS prior to RNU might increase the IVR risk in patients with UTUC. As ureteroscopy provides important prognostic and therapeutic value and guides decisions in UTUC, more future studies should be performed to find a novel way to mitigate the potential risk of IVR after RNU, such as chemoprophylaxis after endoscopy.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

et al. 2017

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“…Further, the cancer control efficacy of this management approach has been established [5,6]. Cytopathological analysis of upper tract barbotage specimens or brush biopsies has poor sensitivity in cases of low-grade TCC [7,8]. Keeley et al [8] performed combined upper urinary tract lavage, multiple ureteroscopic biopsies and cell block cytopathological analysis to make the diagnosis of urothelial carcinoma in 94% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Cytopathological analysis of upper tract barbotage specimens or brush biopsies has poor sensitivity in cases of low-grade TCC [7,8]. Keeley et al [8] performed combined upper urinary tract lavage, multiple ureteroscopic biopsies and cell block cytopathological analysis to make the diagnosis of urothelial carcinoma in 94% of cases. They also stated that biopsies were obtained using a forceps device and basket.…”

Section: Discussionmentioning

confidence: 99%

Can We Improve the Biopsy Quality of Upper Urinary Tract Urothelial Tumors? Single-Center Preliminary Results of a New Biopsy Forceps

Alqahtani¹,

Legraverend²,

Medina³

et al. 2014

Urol Int

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Objective: Our aim was to evaluate the biopsy quality of upper urinary tract urothelial transitional cell carcinoma with a new biopsy forceps (BIGopsy®, Cook Medical) compared to a classic biopsy forceps (Piranha®, Boston Scientific). Patients and Methods: From December 2009 to December 2011, 20 patients with upper urinary tract urothelial transitional cell carcinoma underwent conservative treatment endoscopically. All lesions were evaluated and biopsied with 3 Fr cup forceps using both types of forceps (BIGopsy and Piranha). A single pathologist blindly analyzed the specimens in order to determine the optimal biopsy for each patient. Specimen histopathology results were graded; however, they were staged if the lamina propria was not invaded (T1) or if the tumor was detected at the lamina propria (T1+). Results: Of the 20 upper urinary tract lesions, 12 (60%) were in the renal pelvis, 3 (15%) in the upper calyx, 1 (5%) in the middle calyx, 1 (5%) in the lower calyx, 1 (5%) in the upper third of the ureter and 2 (10%) in the middle third of the ureter. We did not detect T1 in all biopsies. One patient had no valid biopsies by both forceps. A diagnosis of urothelial carcinoma was made in 17 BIGopsy biopsies compared to 7 Piranha biopsies. Conclusion: Despite the limited number of cases, our study demonstrated the advantage of the new forceps (BIGopsy) in obtaining a valid biopsy of upper urinary tract urothelial tumors. Therefore, we recommend it in evaluating this pathology for optimal treatment.

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“…As a result, they are difficult to diagnose and often nondiagnostic, leading to uncertainty about treatment. The techniques for biopsy as well as specimen handling and processing are crucial and have been described previously [3,4,5]. …”

Section: Discussionmentioning

confidence: 99%

Does Mitosis-Specific Marker Phosphohistone H3 Help the Grading of Upper Tract Urothelial Carcinomas in Cell Blocks?

Solomides¹,

Birbe²,

Nicolaou³

et al. 2012

Acta Cytologica

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Background: Grading upper tract urothelial carcinomas (UTUC) in cell blocks with small distorted tissue fragments can be challenging; interobserver agreement is poor among pathologists. Mitotic figure (MF) counting along with nuclear features is important in grading these tumors. We evaluated the use of the mitotic-specific marker phosphohistone H3 (PHH3) as an adjunct to hematoxylin and eosin (H&E) stain for grading UTUC in cell blocks. Methods: Formalin-fixed, paraffin-embedded tissues from the cell blocks of 61 UTUC were stained with H&E and PHH3 antibody. The grading of tumors was performed independently by 3 pathologists, on both H&E-stained and PHH3 plus H&E-stained slides. The grading system used was the 1973 WHO 3-point grading system. Gradings were compared by all the pathologists for H&E staining versus PHH3 plus H&E staining with the Stuart-Maxwell test of marginal homogeneity that accounts for the matched data. Results: The average pairwise agreement by H&E alone was 55%, and 80% by PHH3 plus H&E. Conclusion: By adding PHH3 immunostain to the H&E, the agreement in grading the carcinomas among the 3 pathologists improved dramatically. PHH3 immunostain may play an important role in grading UTUC in small cell block samples.

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Diagnostic Accuracy of Ureteroscopic Biopsy in Upper Tract Transitional Cell Carcinoma

Abstract: Ureteroscopic inspection and biopsy combined with cytological techniques provide accurate information regarding grade and stage of upper tract transitional cell carcinoma.

Cited by 252 publications

References 21 publications

Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

Can We Improve the Biopsy Quality of Upper Urinary Tract Urothelial Tumors? Single-Center Preliminary Results of a New Biopsy Forceps

Does Mitosis-Specific Marker Phosphohistone H3 Help the Grading of Upper Tract Urothelial Carcinomas in Cell Blocks?

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