Williams Steve K, Denton Karin J, Minervini Andrea, Oxley Jon, Khastigir Jay, Timoney Anthony G, Keeley Francis X
The Bristol Urological Institute, Bristol, United Kingdom.
J Endourol. 2008 Jan;22(1):71-6. doi: 10.1089/end.2007.9853.
To determine the accuracy of radiographic studies, ureteroscopy, biopsy, and cytology in predicting the histopathology of upper-tract transitional cell carcinoma (TCC).
From 1998 to 2006, 46 upper-tract lesions were diagnosed ureteroscopically and underwent nephroureterectomy, and 30 of them were subjected to direct ureteroscopic inspection and biopsy. Fresh samples were delivered to the cytopathology laboratory and histology samples were prepared whenever visible tissue was present. Radiological, ureteroscopic, cytology, and biopsy data were compared to the actual grades and stages of these 30 surgical specimens.
Retrograde ureteropyelography was suggestive of malignancy in 29 of 30 cases, but did not predict the grade or stage accurately. Cytology was positive for malignancy in 21 of 30 cases (70%). Grading of ureteroscopic specimens was possible in all cases. At nephroureterectomy two cases were found to have no tumor (T(0)). Of the remaining 28 cases, the biopsy grade proved to be identical in 21 (75%). Grade 1 or 2 ureteroscopic specimens had a low-stage (T(0), T(a), or T(1)) tumor in 17 of 25 (68%); in contrast, 3 of 5 (60%) high-grade specimens had invasive tumor (T(2) or T(3)). For patients with grade 2 ureteroscopic specimens, combining exfoliated cell cytology and biopsy grade improved the accuracy in predicting high-stage and high-grade disease.
This study confirms previous findings that ureteroscopic inspection and biopsy provides accurate information regarding the grade and stage of upper-tract TCC. Combining exfoliated cell cytology improves the predictive power of biopsy grade 2 disease for high-risk specimen grade and stage. Our data suggest that ureteroscopic findings may predict muscle invasion.
确定放射学检查、输尿管镜检查、活检及细胞学检查在预测上尿路移行细胞癌（TCC）组织病理学方面的准确性。
1998年至2006年期间，46例上尿路病变经输尿管镜诊断并行肾输尿管切除术，其中30例接受了直接输尿管镜检查及活检。只要有可见组织，新鲜样本即被送至细胞病理学实验室并制备组织学样本。将放射学、输尿管镜、细胞学及活检数据与这30例手术标本的实际分级和分期进行比较。
逆行输尿管肾盂造影在30例中有29例提示恶性，但未准确预测分级或分期。30例中有21例（70%）细胞学检查呈恶性阳性。所有病例均可行输尿管镜标本分级。肾输尿管切除术中发现2例无肿瘤（T(0)）。其余28例中，21例（75%）活检分级与之相同。25例中17例（68%）1级或2级输尿管镜标本为低分期（T(0)、T(a)或T(1)）肿瘤；相比之下，5例中3例（60%）高级别标本有浸润性肿瘤（T(2)或T(3)）。对于输尿管镜标本为2级的患者，联合脱落细胞细胞学检查和活检分级可提高预测高分期和高级别疾病的准确性。
本研究证实了先前的发现，即输尿管镜检查及活检可提供有关上尿路TCC分级和分期的准确信息。联合脱落细胞细胞学检查可提高活检2级疾病对高风险标本分级和分期的预测能力。我们的数据表明输尿管镜检查结果可能预测肌肉浸润情况。
