Ureteroscopy in the Diagnosis of Upper Tract Transitional Cell Cancer: A 10-Year Experience Providing Outcome Data for Informed Consent

Abstract

Purpose The aim of the study was to assess the effectiveness of ureteroscopy and biopsy in the diagnosis and management of upper tract urothelial carcinoma. Methods We retrospectively collated data from pathology, radiology and operating theatre data sets from two large UK hospitals. During the 10-year period examined, 160 patients underwent ureteroscopy prior to nephro-ureterectomy (NU)/distal ureterectomy (DU). Results Of the 160 patients identified, 140 were ureteroscopically evaluated and biopsied, 104 (74.3%) had positive biopsies, 5 (3.6%) had negative biopsies and 31 (22.1%) had nondiagnostic biopsies. One hundred and forty patients of 160 (88.8%) resulted in positive findings as a result of their ureteroscopy [positive biopsy/positive operative cytology/visible upper tract urothelial carcinoma (UTUC) at ureteroscopy)]. A total of 108 patients had cytological samples sent for histological analysis where grade was able to be assessed at DU/NU. Of these samples, 35 had positive cytology, 58 had an abnormal result that was not diagnostic and 15 had negative cytology. Patients with positive biopsies had upstaging (58.4%) and/or upgrading (30.5%) of their initial ureteroscopic histology at NU/DU. The overall success rate of ureteroscopy for cancer diagnosis was 88.8%. Conclusions Upper tract endoscopy and biopsy yielded positive biopsy results in 74.3% of cases and confirmed a cancer diagnosis in 88.8%. Five patients had negative histology at biopsy, all of whom eventually underwent a NU/DU confirming cancer.