Wang Lu, Pambuccian Stefan E, Wojcik Eva M, Barkan Güliz A
Department of Pathology and Lab Medicine, Loyola University Medical Center, 2160 W. 1st Avenue, Maywood, Illinois.
Department of Pathology and Lab Medicine, Loyola University Medical Center, 2160 W. 1st Avenue, Maywood, Illinois.
J Am Soc Cytopathol. 2015 Jan-Feb;4(1):3-9. doi: 10.1016/j.jasc.2014.09.203. Epub 2014 Sep 8.
Upper tract urothelial carcinoma (UTUC) is defined as urothelial carcinoma (UC) arising in the renal pelvis and ureter. Upper tract (UT) cytology and biopsy evaluation can be technically challenging. The aim of the study is to evaluate the diagnostic modality and sensitivity of urine cytology and ureteroscopic biopsy for the diagnosis of UTUC.
All patients with UTUC who underwent radical nephroureterectomy or ureterectomy with preoperative cytology and/or biopsy from January 1, 2000 to September 30, 2011 at our institution were included in this study. The sensitivity of each diagnostic modality was calculated with respect to tumor grade, stage, and size.
A total of 143 cytology specimens and 54 biopsies from 65 patients were evaluated. For low-grade UTUC, the sensitivities for biopsy, lower tract cytology, and UT cytology were 68.4%, 27.3%, and 37.5%, respectively. These numbers were 82.9%, 40.7%, and 80.6% for high-grade UTUC. By combining the UT cytology and biopsy, the diagnostic sensitivities were increased to 87.5% for low-grade UTUC and 100% for high-grade UTUC. The consistency of tumor grade between biopsy and surgical specimen were 63.2% for low-grade UTUC and 68.6% for high-grade UTUC.
Both UT cytology and biopsy showed higher sensitivity in detecting high-grade UTUC versus low-grade UTUC. The sensitivities of UT cytology and ureteroscopic biopsy in detecting high-grade UTUC were comparable. The sensitivity was greatly improved when these diagnostic modalities were combined. As expected, the selective UT cytology evaluation had superior sensitivity in detecting UTUC than did the lower tract cytology sampling.
上尿路尿路上皮癌（UTUC）被定义为发生在肾盂和输尿管的尿路上皮癌（UC）。上尿路（UT）细胞学检查和活检评估在技术上可能具有挑战性。本研究的目的是评估尿液细胞学检查和输尿管镜活检对UTUC诊断的诊断方式和敏感性。
纳入2000年1月1日至2011年9月30日在我院接受根治性肾输尿管切除术或输尿管切除术且术前行细胞学检查和/或活检的所有UTUC患者。计算每种诊断方式相对于肿瘤分级、分期和大小的敏感性。
共评估了来自65例患者的143份细胞学标本和54份活检标本。对于低级别UTUC，活检、下尿路细胞学检查和UT细胞学检查的敏感性分别为68.4%、27.3%和37.5%。对于高级别UTUC，这些数字分别为82.9%、40.7%和80.6%。通过联合UT细胞学检查和活检，低级别UTUC的诊断敏感性提高到87.5%，高级别UTUC提高到100%。低级别UTUC活检与手术标本之间肿瘤分级的一致性为63.2%，高级别UTUC为68.6%。
UT细胞学检查和活检在检测高级别UTUC方面均比低级别UTUC具有更高的敏感性。UT细胞学检查和输尿管镜活检在检测高级别UTUC方面的敏感性相当。当这些诊断方式联合使用时，敏感性得到极大提高。正如预期的那样,选择性UT细胞学评估在检测UTUC方面比下尿路细胞学采样具有更高的敏感性。
