AJCY2403 - CME/CMLE - Diagnostic accuracy of upper tract urothelial carcinoma using biopsy, urinary cytology, and nephroureterectomy specimens-Diagnostic accuracy of upper tract urothelial carcinoma using biopsy, urinary cytology, and nephroureterectomy specimens

Diagnostic accuracy of upper tract urothelial carcinoma using biopsy, urinary cytology, and nephroureterectomy specimens

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The study published in the American Journal of Clinical Pathology addresses diagnostic challenges of upper tract urothelial carcinoma (UTUC) using small biopsy specimens. The key findings indicate that biopsy specimen size and tumor size significantly affect diagnostic accuracy, resulting in discordance between biopsy and nephroureterectomy (surgical resection) specimens. The study involved 69 patients, predominantly men (48 males, 21 females), with a mean age of 69 years. Pathologic features, such as tumor size, grade, invasion status, tumor architecture, and location, were analyzed.<br /><br />The study found that 71% of the biopsy results were concordant with the final surgical pathology regarding tumor grade. However, smaller biopsy specimens were associated with diagnostic discordance for both tumor grading and invasion status. High-grade urothelial carcinoma was correctly diagnosed in 84% of cases using upper tract urinary cytology, highlighting its high diagnostic accuracy.<br /><br />Upper tract cytology and biopsy, when combined, resulted in an overall diagnostic accuracy of 85%, slightly higher than cytology alone. This supports the recommendation to use urinary cytology as a complementary diagnostic tool.<br /><br />Challenges included obtaining sufficient tissue, especially in cases involving the renal pelvis where the muscularis is underdeveloped. Accurate pathologic diagnosis plays a critical role in treatment decisions, where discordance can lead to changes in clinical management. The study highlights that larger tumors often exhibit histologic heterogeneity, leading to discordance if the biopsy misses high-grade or invasive areas.<br /><br />In conclusion, the study underscores the need for sufficient and deep biopsy sampling, while also advocating for the incorporation of upper tract cytology to improve diagnostic accuracy for UTUC, thereby aiding in better clinical decision-making. The supportive funding from various institutions emphasizes the collaborative effort to improve cancer diagnostics.

Keywords

upper tract urothelial carcinoma

UTUC

biopsy specimens

diagnostic accuracy

tumor grading

urinary cytology

pathologic features

clinical management

histologic heterogeneity

cancer diagnostics