Department of Urology, Groβhadern University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.
Urol Oncol. 2013 Oct;31(7):1166-70. doi: 10.1016/j.urolonc.2011.12.021. Epub 2012 Jan 31.
To determine accuracy of upper tract cytology and ureteroscopic biopsy according to the 2004 World Health Organization (WHO) classification in predicting the correct tumor grade in patients with urothelial cancer of the upper urinary tract (UUT-UC).
Pathology reports of 77 nephroureterectomy specimens were retrospectively analyzed for tumor grade and compared with preoperatively gained cytology and ureteroscopic biopsy results. For analysis, the 2004 WHO classification was used.
Overall sensitivity of cytology and biopsy in diagnosis of UUT-UC was 64% and 74%, respectively. Accuracy of cytology and biopsy in predicting high grade cancer was 53% and 58%, respectively. Combination of cytology and biopsy could improve sensitivity (84%) and accuracy (68%), but even for this combination, 15% of high grade tumors were misinterpreted as low grade cancer.
Our results show only limited accuracy for preoperative cytology and ureterorenoscopically performed biopsies in the prediction of the correct tumor grading of an UUT-UC. Therefore, we suggest the use of additional diagnostic procedures before the decision for definitive surgical treatment in patients with UUT-UC is made.
根据 2004 年世界卫生组织（WHO）分类，确定上尿路尿路上皮癌（UUT-UC）患者上尿路细胞学和输尿管镜活检预测正确肿瘤分级的准确性。
回顾性分析 77 例肾输尿管切除术标本的病理学报告，比较术前细胞学和输尿管镜活检结果。分析采用 2004 年 WHO 分类。
细胞学和活检诊断 UUT-UC 的总体敏感性分别为 64%和 74%。细胞学和活检预测高级别癌症的准确性分别为 53%和 58%。细胞学和活检的联合应用可提高敏感性（84%）和准确性（68%），但即使联合应用，仍有 15%的高级别肿瘤被误诊为低级别癌症。
我们的结果表明，术前细胞学和输尿管镜下活检在预测 UUT-UC 的正确肿瘤分级方面仅有有限的准确性。因此，我们建议在决定对 UUT-UC 进行确定性手术治疗之前，使用其他诊断程序。
