title: Carcinoma in situ is significantly underdetected by prenephroureterectomy ureteroscopy in the management of upper tract urothelial cancers.
abstract: Objective. Diagnostic reliability of prenephroureterectomy ureteroscopy (PNU) for the detection of upper tract carcinoma in situ (CIS) remains unproven in particular and underreported in general. Methods. Patients who underwent radical nephroureterectomy (RNU) in a large multicentre retrospective study for upper tract transitional cell carcinoma (UT-TCC) between January 2002 and December 2013 were identified from our hospitals databases. PNU appearances, stage, and grade of ureteroscopic biopsy were compared with final histology results of RNU to assess the diagnostic reliability of PNU for carcinoma in situ (CIS). Results. Three hundred patients underwent RNU for UT-TCC. 106 (106/300; 35.3%) of the cohort had PNU using white light with biopsies taken in most (92/106; 86.7%). Postnephroureterectomy histology of the cohort showed CIS in 65 (65/300; 21.6%) patients. Thirty nine of patients with CIS (39/65; 60%) had prenephroureterectomy ureteroscopy biopsies. Out of ten patients with CIS on ureteroscopic biopsies, six did not show CIS on final histopathology (6/10; 60%). Moreover, grading and staging on PNU biopsies of obvious tumours showed a significant nonconcordance with final histopathology of RNU specimen (P = 0.02). Overall survival was also shorter in patients with CIS compared with those without; this showed strong statistical significance (P = 0.004). Conclusions. There is a high incidence of CIS in upper tract with significant underdetection and discordance rate between the histopathology of biopsy samples obtained by white light PNU and resected specimen of radical nephroureterectomy. The presence of concomitant CIS and high stage disease in the upper tract TCC carried a poor prognosis following radical nephroureterectomy.
authors: Academic Section of Urology, Division of Imaging and Technology Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK.
authors: Angela
authors: 0000-0001-5557-750X
authors: A
authors: Gillan
authors: Academic Section of Urology, Division of Imaging and Technology Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK.
authors: Ismail
authors: 0000-0002-1511-8314
authors: I
authors: El-Mokadem
authors: Academic Section of Urology, Division of Imaging and Technology Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK.
authors: Bhavan
authors: B
authors: Rai
authors: Department of Pathology, Ninewells Hospital, NHS Tayside Health Board, Dundee DD1 9SY, UK.
authors: Stephen
authors: S
authors: Lang
authors: Department of Urology, Pinderfield General Hospital and Mid Yorkshire NHS Trust, Wakefield, UK.
authors: Jason
authors: J
authors: Alcorn
authors: Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK.
authors: Altaf
authors: A
authors: Shams Ud Din
authors: Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK.
authors: Ranan
authors: R
authors: Dasgupta
authors: Department of Urology, Pinderfield General Hospital and Mid Yorkshire NHS Trust, Wakefield, UK.
authors: Chandra Shekhar
authors: CS
authors: Biyani
authors: Academic Section of Urology, Division of Imaging and Technology Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK.
authors: Ghulam
authors: G
authors: Nabi
mesh_terms: D000368:Aged; D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis*; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012015:Reference Standards; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy; D019459:Urothelium / Q000473:pathology*
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