Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033-0850, USA.
J Endourol. 2012 Apr;26(4):398-402. doi: 10.1089/end.2011.0426. Epub 2012 Feb 24.
Accurate assessment of upper-tract urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results.
URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (<pT(2)), or muscle invasive (MI; ≥pT(2)). Grade was classified as low or high.
On URS biopsy, 88/238 (37%) patients had a positive brush, 140 (59%) had a diagnosis of non-MI, and 10 (4%) had MI disease. Biopsy results showed low-grade cancer in 140 (59%) and high-grade cancer in 98 (41%). Pathologic evaluation at surgical resection demonstrated non-MI tumors in 140 (59%) patients, MI in 98 (41%), and high-grade disease in 150 (63%). On univariate analysis, high URS biopsy grade was associated with high-grade (positive predictive value [PPV] 92%, P<0.0001) and MI (PPV 60%, P<0.0001) UTUC at surgery. URS biopsy stage, however, was associated with surgical pathology grade (P=0.005), but not MI (P=0.16) disease. On multivariate analysis, high URS grade, but not biopsy stage, was associated with high final pathology grade (hazard ratio [HR] 16.6, 95% confidence interval [CI] 7.0-39.5, P<0.0001) and MI UTUC (HR 3.6, 95% CI 2.1-6.8, P<0.0001).
High URS biopsy grade, but not stage, is associated with adverse tumor pathology. This information may play a valuable role for risk stratification and in the appropriate selection of endoscopic management vs surgical extirpation for UTUC.
准确评估上尿路尿路上皮癌（UTUC）的病理情况有助于指导选择内镜治疗还是根治性治疗。本研究通过对接受手术治疗的 UTUC 患者进行多中心回顾性分析，旨在描述输尿管镜活检特征与最终病理结果之间的关系。
本研究纳入 238 例行 UTUC 根治性切除术的患者，所有患者均有输尿管镜活检资料。活检时使用刷检套件、机械活检装置或篮状活检钳。根据输尿管镜下活检结果将肿瘤分期分为阳性刷检（非肌层浸润性< pT(2) ）、非肌层浸润性（ pT(2) ）或肌层浸润性（≥ pT(2) ）。根据肿瘤分级将活检结果分为低级别或高级别。
输尿管镜活检示阳性刷检的患者有 88 例（37%），非肌层浸润性肿瘤 140 例（59%），肌层浸润性肿瘤 10 例（4%）。活检结果显示低级别肿瘤 140 例（59%），高级别肿瘤 98 例（41%）。术后病理评估示非肌层浸润性肿瘤 140 例（59%），肌层浸润性肿瘤 98 例（41%），高级别肿瘤 150 例（63%）。单因素分析显示，输尿管镜活检高级别肿瘤与高级别肿瘤（阳性预测值[PPV]为 92%， P<0.0001）和肌层浸润性肿瘤（PPV 为 60%， P<0.0001）显著相关。而输尿管镜活检分期与手术病理分级（ P=0.005）相关，但与肌层浸润性肿瘤（ P=0.16）无关。多因素分析显示，输尿管镜活检高级别肿瘤与高级别肿瘤（风险比[HR]为 16.6，95%置信区间[CI]为 7.0-39.5， P<0.0001）和肌层浸润性肿瘤（HR 为 3.6，95%CI 为 2.1-6.8， P<0.0001）显著相关，而与肿瘤分期无关。
输尿管镜活检高级别肿瘤与不良肿瘤病理情况相关。该信息有助于对患者进行风险分层，并有助于选择内镜治疗还是根治性手术治疗。
