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Cytologic analysis of ureteral washings is informative in patients with grade 2 upper tract TCC considering endoscopic treatment

Lookup NU author(s): Thomas Griffiths, Philip Powell, David Thomas, Professor David Neal, John Kelly


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Objectives. To determine the diagnostic accuracy of ureteroscopic biopsy and whether exfoliated cell cytology can improve diagnostic accuracy. Methods. Sixty-two cases of upper tract transitional cell carcinoma were diagnosed by ureteroscopic biopsy and treated by nephroureterectomy. Stage and grade evaluation was possible in 51 cases. Cytology for exfoliated cells from the ureter/pelvis was available in 48 cases. Results. Biopsies were staged as Tis in 3, Ta in 35, and T1 in 13 and graded as G 1 in 6, G2 in 32, and G3 in 13. Cytology was positive/suspicious in 40% (19 of 48). The biopsy grade accurately predicted the pathologic grade (P <0.0001) and stage (P = 0.001). The biopsy stage was not associated with the final stage (P = 0.112, Fisher's exact test). Biopsy G3 accurately predicted high-grade (G3) transitional cell carcinoma in 92% (12 of 13) of cases. The remaining 1 case was G2 by final histologic examination. No case of high-grade (G3) disease was found in the 6 G1 biopsies (100%). Of 32 G2 biopsies, 9 were upgraded to G3. Cytology was available for 8 of the 9 and 5 (63%) were positive. For patients with G2 biopsies, combining cytology and biopsy grade improved the sensitivity and specificity of high-grade tumor detection from 43% to 55% and 23% to 85%, respectively. Conclusions. The results of this study have shown that biopsy grade reflects the pathologic stage and grade. Combining exfoliated cell cytology improved the predictive power of biopsy G2 disease for high-risk specimen grade. Exfoliated cell cytology in combination with biopsy grade is recommended as part of the evaluation of upper tract transitional cell carcinoma selected for endoscopic management. (C) 2003 Elsevier Inc.

Publication metadata

Author(s): Skolarikos A, Griffiths TRL, Powell PH, Thomas DJ, Neal DE, Kelly JD

Publication type: Article

Publication status: Published

Journal: Urology

Year: 2003

Volume: 61

Issue: 6

Pages: 1146-1150

ISSN (print): 0090-4295

ISSN (electronic): 1527-9995

Publisher: Excerpta Medica, Inc.


DOI: 10.1016/S0090-4295(03)00026-8


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