Adult urologyCytologic analysis of ureteral washings is informative in patients with grade 2 upper tract TCC considering endoscopic treatment
Section snippets
Material and methods
Between July 1989 and July 2001, 140 patients with a mean age of 69 years (range 41 to 91) were diagnosed with UUT-TCC and treated by nephroureterectomy. Sixty-two patients who had UUT-TCC and no concomitant bladder TCC completed endoscopic investigations, which included ureteropyelography, ureteroscopy, and biopsy of the tumor before open surgery. A total of 37 left and 25 right collecting systems were affected in 40 men and 22 women. The conditions at presentation included gross and
Results
Of the 62 patients who underwent ureteroscopic biopsy, grade and stage evaluation was possible in 51 cases (82%; Table I).
Comment
Conservation of renal units in patients with UUT-TCC lies in the ability to accurately exclude patients with high-grade invasive tumors who are at increased risk of local recurrence6, 9 and early death.7, 17 The results of our retrospective study not only confirm the diagnostic accuracy of biopsy grade but also identified the clinical utility of exfoliative cytology, obtained from gentle ureteral washings, in further defining patients with grade 2 biopsies who can safely pursue endoscopic
Conclusions
Our data suggest that in patients with ureteroscopic biopsy grade 2 tumors, the demonstration of malignant cells obtained by gentle upper tract washings before biopsy usually indicates undetected high-grade TCC. Patients with biopsy TaG2 UUT-TCC and positive cytology require nephroureterectomy. Patients with TaG1 biopsies can be safely treated endoscopically. Patients with TaG2 biopsies and negative cytology may be candidates for endoscopic treatment, but a small chance of understaging still
Acknowledgements
To the Newcastle upon Tyne Hospitals Special Trustees who funded a part-time data manager to underpin the project.
References (22)
- et al.
Primary carcinoma of the uretera report of 102 new cases
J Urol
(1970) - et al.
Ureteroscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys
J Urol
(2000) - et al.
Is nephroureterectomy necessary in all cases of upper tract transitional cell carcinoma? Long-term results of conservative endourologic management of upper tract transitional cell carcinoma in individuals with a normal contralateral kidney
Urology
(2001) - et al.
Long-term outcome after percutaneous treatment of transitional cell carcinoma of the renal pelvis
J Urol
(1996) - et al.
Long-term follow-up of endoscopically treated upper urinary tract transitional cell carcinoma
Urology
(1996) - et al.
Upper-tract transitional cell carcinoma
Urology
(1997) - et al.
Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma
J Urol
(1997) - et al.
Ureteroscopic biopsy of upper tract urothelial carcinomaimproved diagnostic accuracy and histopathological considerations using a multi-biopsy approach
J Urol
(2000) - et al.
Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma
J Urol
(1997) - et al.
Flexible ureteropyeloscopydiagnosis and treatment in the upper urinary tract
J Urol
(1987)
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