title: Correlation of upper-tract cytology, retrograde pyelography, ureteroscopic appearance, and ureteroscopic biopsy with histologic examination of upper-tract transitional cell carcinoma.
abstract: OBJECTIVE
  To determine the accuracy of radiographic studies, ureteroscopy, biopsy, and cytology in predicting the histopathology of upper-tract transitional cell carcinoma (TCC).
  
  
  METHODS
  From 1998 to 2006, 46 upper-tract lesions were diagnosed ureteroscopically and underwent nephroureterectomy, and 30 of them were subjected to direct ureteroscopic inspection and biopsy. Fresh samples were delivered to the cytopathology laboratory and histology samples were prepared whenever visible tissue was present. Radiological, ureteroscopic, cytology, and biopsy data were compared to the actual grades and stages of these 30 surgical specimens.
  
  
  RESULTS
  Retrograde ureteropyelography was suggestive of malignancy in 29 of 30 cases, but did not predict the grade or stage accurately. Cytology was positive for malignancy in 21 of 30 cases (70%). Grading of ureteroscopic specimens was possible in all cases. At nephroureterectomy two cases were found to have no tumor (T(0)). Of the remaining 28 cases, the biopsy grade proved to be identical in 21 (75%). Grade 1 or 2 ureteroscopic specimens had a low-stage (T(0), T(a), or T(1)) tumor in 17 of 25 (68%); in contrast, 3 of 5 (60%) high-grade specimens had invasive tumor (T(2) or T(3)). For patients with grade 2 ureteroscopic specimens, combining exfoliated cell cytology and biopsy grade improved the accuracy in predicting high-stage and high-grade disease.
  
  
  CONCLUSIONS
  This study confirms previous findings that ureteroscopic inspection and biopsy provides accurate information regarding the grade and stage of upper-tract TCC. Combining exfoliated cell cytology improves the predictive power of biopsy grade 2 disease for high-risk specimen grade and stage. Our data suggest that ureteroscopic findings may predict muscle invasion.
authors.affiliation: The Bristol Urological Institute, Bristol, United Kingdom.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Williams
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Denton
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.forename: Jon
authors.initials: J
authors.lastname: Oxley
authors.forename: Jay
authors.initials: J
authors.lastname: Khastigir
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Timoney
authors.forename: Francis X
authors.initials: FX
authors.lastname: Keeley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014516:Ureteral Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D018666:Ureteroscopy; D014567:Urography