Inadequacy of Biopsy for Diagnosis of Upper Tract Urothelial Carcinoma: Implications for Conservative Management

Smith, Arthur L.; Stephenson, Andrew J.; Lane, Brian R.; Larson, Benjamin T.; Thomas, Anil A.; Gong, Michael C.; Jones, J. Stephen; Campbell, Steven C.; Hansel, Donna E.

doi:10.1016/j.urology.2011.02.038

Cited by 168 publications

(87 citation statements)

References 25 publications

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“…This may yield suboptimal tissue for accurately diagnosing, grading, and staging biopsy specimens taken from the upper urinary tract. [8][9][10][11][12][13][14][15] Errors stemming from insufficient sampling or pathologic misdiagnosis may unnecessarily delay surgical intervention. Thus, determining the specificity and sensitivity of upper tract endoscopic biopsy for the histopathologic diagnosis of urothelial carcinoma is critical.…”

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confidence: 99%

“…[16][17][18] Lastly, the accuracy of tumor grading and staging has been evaluated in a few articles, but no previous analysis has correlated the accuracy of these factors with biopsy sample size. 10,[12][13][14][15]19 The purpose of this investigation was to assess the histopathologic diagnostic accuracy of specimens from the ureter, renal pelvis, and ureteropelvic junction obtained via endoscopic biopsy and to determine the specificity and sensitivity for ureteroscopic biopsy, based upon histopathologic findings. We further correlated both diagnosis and biopsy location with biopsy sample size.…”

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confidence: 99%

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Utility and Diagnostic Accuracy of Ureteroscopic Biopsy in Upper Tract Urothelial Carcinoma

Vashistha

Shabsigh

Zynger

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Ureteroscopic biopsy is the gold standard for the histopathologic diagnosis of urothelial carcinoma of the upper urinary tract.Objective.-To assess the accuracy of endoscopically obtained biopsy samples in diagnosing, grading, and staging urothelial carcinoma and correlate diagnostic findings to biopsy sample size.Design.-We retrospectively reviewed endoscopic biopsies of the ureter, renal pelvis, and ureteropelvic junction from 2008 to 2011. Biopsy diagnoses that were discordant with follow-up pathology and/or ureteroscopic impression were rereviewed and samples were immunohistochemically analyzed.Results.-Endoscopic biopsies (n ¼ 118) yielded a sensitivity of 85.4% for the ureter (n ¼ 79), 77.8% for the renal pelvis (n ¼ 37), and 100% for the ureteropelvic junction (n ¼ 2). A specificity of 100% for all locations and a diagnostic accuracy of 98.3% were identified. The median sample size was 0.3 cm for true positives, 0.3 cm for true negatives, and 0.2 cm for false negatives with no statistical significance. We found that 87.1% of tumors diagnosed on biopsy had concordant grade and 60.0% had concordant pT stage with follow-up surgical resections (n ¼ 43) and biopsies (n ¼ 24). Biopsy samples with concordant tumor grades (mean ¼ 0.6 cm) compared with follow-up resection were larger than biopsy samples with discordant grades (mean ¼ 0.3 cm) (P ¼ .04).Conclusions.-Though highly specific, endoscopic biopsy does provide a significant false-negative rate owing to both sampling and diagnostic errors when assessing the upper urinary tract for urothelial carcinoma. Tumor grading is accurate, particularly with larger tissue samples, but tumor staging is unreliable.

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confidence: 99%

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confidence: 99%

Utility and Diagnostic Accuracy of Ureteroscopic Biopsy in Upper Tract Urothelial Carcinoma

Vashistha

Shabsigh

Zynger

2013

Archives of Pathology &Amp; Laboratory Medicine

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“…Furthermore, disease recurrence rates in UTUC patients were reported to be 22-47% in the bladder (11,12) and 2-6% in the contralateral upper tract (13,14). Localized in the upper urinary tract, these tumors hamper adequate tissue sampling under ureteroscopy and impede proper clinical staging (15). It should also be considered that the gold standard therapeutic modality for invasive UTUC is radical nephroureterectomy which often leads to an acquired loss of renal function (16).…”

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confidence: 99%

Vinflunine in the Τreatment of Upper Tract Urothelial Carcinoma – Subgroup Analysis of an Observational Study

Heers

Geeter

Goebell

et al. 2017

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“…Despite significant technologic advancements in endourology over the last two decades, ureteroscopic biopsy remains technically challenging and has several recognized limitations. [5][6][7] Tissue quantity is insufficient for diagnosis in up to 25% of ureteroscopic biopsies. 8 Variability in tumor sampling can contribute to the *30% rate in upgrading of low-grade UTUC from the time of endoscopic biopsy to definitive nephroureterectomy.…”

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confidence: 99%

“…8 Variability in tumor sampling can contribute to the *30% rate in upgrading of low-grade UTUC from the time of endoscopic biopsy to definitive nephroureterectomy. 5,7 Inaccurate diagnosis from ureteroscopic biopsy can negatively affect patient prognosis and prevent optimal clinical management. 9 Several optical imaging technologies have been proposed to improve the diagnosis of UTUC, with the goal to better stratify patients for renal-sparing management options and long-term endoscopic surveillance.…”

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confidence: 99%

A Pilot Study of In Vivo Confocal Laser Endomicroscopy of Upper Tract Urothelial Carcinoma

Bui

Mach

Zlatev

et al. 2015

Journal of Endourology

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Purpose: Tissue diagnosis of upper tract urothelial carcinoma (UTUC) is limited by variance in tumor sampling by standard ureteroscopic biopsy. Optical imaging technologies can potentially improve UTUC diagnosis, surveillance, and endoscopic treatment. We previously demonstrated in vivo optical biopsy of urothelial carcinoma of the bladder using confocal laser endomicroscopy (CLE). In this study, we evaluated a new 0.85-mm imaging probe in the upper urinary tract and demonstrated feasibility and compatibility with standard ureteroscopes to achieve in vivo optical biopsy of UTUC. Materials and Methods: Fourteen patients scheduled for ureteroscopy of suspected upper tract lesions or surveillance of UTUC were recruited. After intravenous (IV) administration of fluorescein, CLE was performed using a 0.85-mm-diameter imaging probe inserted through the working channel of standard ureteroscopes. Acquired confocal video sequences were reviewed and analyzed. A mosaicing algorithm was used to compile a series of images into a single larger composite image. Processed CLE images were compared with standard histopathologic analysis. Results: Optical biopsy of the UTUC using CLE was effectively achieved during standard ureteroscopy. There were no adverse events related to IV fluorescein administration or image acquisition. Confocal imaging of UTUC showed characteristic features similar to urothelial carcinoma of the bladder, including papillary structure, fibrovascular stalks, and pleomorphism. Lamina propria in normal areas of the renal pelvis and ureter was also identified. Conclusions: We report an initial feasibility of CLE of UTUC. Pending further clinical investigation, CLE may become a useful adjunct to ureteroscopic biopsy, endoscopic ablation, and surveillance of UTUC.

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Inadequacy of Biopsy for Diagnosis of Upper Tract Urothelial Carcinoma: Implications for Conservative Management

Cited by 168 publications

References 25 publications

Utility and Diagnostic Accuracy of Ureteroscopic Biopsy in Upper Tract Urothelial Carcinoma

Utility and Diagnostic Accuracy of Ureteroscopic Biopsy in Upper Tract Urothelial Carcinoma

Vinflunine in the Τreatment of Upper Tract Urothelial Carcinoma – Subgroup Analysis of an Observational Study

A Pilot Study of In Vivo Confocal Laser Endomicroscopy of Upper Tract Urothelial Carcinoma

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