title: High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection.
abstract: OBJECTIVE
  Accurate assessment of upper-tract urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results.
  
  
  METHODS
  URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (<pT(2)), or muscle invasive (MI; ≥pT(2)). Grade was classified as low or high.
  
  
  RESULTS
  On URS biopsy, 88/238 (37%) patients had a positive brush, 140 (59%) had a diagnosis of non-MI, and 10 (4%) had MI disease. Biopsy results showed low-grade cancer in 140 (59%) and high-grade cancer in 98 (41%). Pathologic evaluation at surgical resection demonstrated non-MI tumors in 140 (59%) patients, MI in 98 (41%), and high-grade disease in 150 (63%). On univariate analysis, high URS biopsy grade was associated with high-grade (positive predictive value [PPV] 92%, P<0.0001) and MI (PPV 60%, P<0.0001) UTUC at surgery. URS biopsy stage, however, was associated with surgical pathology grade (P=0.005), but not MI (P=0.16) disease. On multivariate analysis, high URS grade, but not biopsy stage, was associated with high final pathology grade (hazard ratio [HR] 16.6, 95% confidence interval [CI] 7.0-39.5, P<0.0001) and MI UTUC (HR 3.6, 95% CI 2.1-6.8, P<0.0001).
  
  
  CONCLUSIONS
  High URS biopsy grade, but not stage, is associated with adverse tumor pathology. This information may play a valuable role for risk stratification and in the appropriate selection of endoscopic management vs surgical extirpation for UTUC.
authors.affiliation: Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033-0850, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clements
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Messer
authors.forename: John D
authors.initials: JD
authors.lastname: Terrell
authors.forename: Michael P
authors.initials: MP
authors.lastname: Herman
authors.forename: Casey K
authors.initials: CK
authors.lastname: Ng
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Benjamin
authors.initials: B
authors.lastname: Scoll
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: Mark
authors.initials: M
authors.lastname: Wille
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
authors.forename: Steven M
authors.initials: SM
authors.lastname: Lucas
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009132:Muscles / Q000473:pathology; D009361:Neoplasm Invasiveness; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*; D019459:Urothelium / Q000473:pathology* / Q000601:surgery*