Diagnostic ureteroscopy (dURS) is optional in the assessment of patients with upper tract urothelial carcinoma (UTUC) and provides the possibility of obtaining histology.
To evaluate endoscopic biopsy techniques and outcomes, we assessed data from patients from the CROES-UTUC registry. The registry includes multicenter prospective collected data on diagnosis and management of patients suspected having UTUC.
We assessed 2380 patients from 101 centers. dURS with biopsy was performed in 31.6% of patients. The quality of samples was sufficient for diagnosis in 83.5% of cases. There was no significant association between biopsy techniques and quality (p = 0.458). High-grade biopsy accurately predicted high-grade disease in 95.7% and high-risk stage disease in 86%. In ureteroscopic low-grade tumours, the prediction of subsequent low-grade disease was 66.9% and low-risk stage Ta-disease 35.8%. Ureteroscopic staging correctly predicted non-invasive Ta-disease and ≥ T1 disease in 48.9% and 47.9% of patients, respectively. Cytology outcomes did not provide additional value in predicting tumour grade.
Biopsy results adequately predict high-grade and high-risk disease, but approximately one-third of patients are under-staged. Two-thirds of patients with low-grade URS-biopsy have high-risk stage disease, highlighting the need for improved diagnostics to better assess patient risk and guide treatment decisions.
The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188 ).
World journal of urology. 2024 Mar 20*** epublish ***
Joyce Baard, Luigi Cormio, Ranan Dasgupta, Daniele Maruzzi, Soroush Rais-Bahrami, Alvaro Serrano, Bogdan Geavlete, Stilianos Giannakopoulos, Jean de la Rosette, Pilar Laguna
Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. ., Department of Urology, University of Foggia, Foggia, Italy., Department of Urology, Imperial College Healthcare NHS Trust, London, UK., Department of Urology, S. Maria Degli Angeli Hospital, Pordenone, Italy., Departments of Urology and Radiology, O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA., Department of Urology, Hospital Clínico San Carlos, Madrid, Spain., Department of Urology, Sanador Hospital, Bucharest, Romania., Department of Urology, School of Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece., Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey.