Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, US.
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, US.
Am J Clin Pathol. 2024 Nov 4;162(5):492-499. doi: 10.1093/ajcp/aqae065.
We studied the diagnostic accuracy and discordance of upper tract urothelial carcinoma (UTUC) by comparing biopsy and urinary cytology with matched nephroureterectomy specimens.
Sixty-nine patients with UTUC without neoadjuvant treatment were retrospectively identified who had matched biopsy and nephroureterectomy specimens. Twenty patients had concurrent upper tract cytology. H&E and cytology slides were re-reviewed. Statistical analysis was performed.
Patients included 48 men and 21 women with a mean age of 69 years. A concordant grade between biopsy and surgical specimen was present in 49 (71%) patients. The mean size of biopsy specimens in the discordant group was significantly smaller than that in the concordant group. Invasion was evaluated in 48 biopsy cases that had adequate subepithelial tissue, and 33 of them were diagnosed with concordant invasion status. Mean tumor size in both tumor grade and invasion discordant groups was significantly larger than that in the concordant group. High-grade urothelial carcinoma was detected in 84% of cases using urinary cytology.
Our study demonstrates the diagnostic challenges of UTUC on small biopsy specimens. Biopsy specimen size and tumor size are significantly associated with the diagnostic discordance. Upper tract cytology showed high diagnostic accuracy and should be complementary to the biopsy.
通过比较活检和尿细胞学与匹配的肾输尿管切除术标本，研究上尿路尿路上皮癌（UTUC）的诊断准确性和不相符性。
回顾性确定了 69 例未经新辅助治疗的 UTUC 患者，这些患者均有匹配的活检和肾输尿管切除术标本。20 例患者同时进行了上尿路细胞学检查。重新审查了 H&E 和细胞学切片。进行了统计分析。
患者包括 48 名男性和 21 名女性，平均年龄为 69 岁。活检和手术标本之间存在一致的分级的患者有 49 例（71%）。在不一致组中活检标本的平均大小明显小于一致组。对 48 例有足够的上皮下组织的活检病例进行了浸润评估，其中 33 例诊断为一致的浸润状态。肿瘤分级和浸润不一致组的平均肿瘤大小均明显大于一致组。尿细胞学检查中 84%的病例检测到高级别尿路上皮癌。
我们的研究表明在小活检标本上诊断 UTUC 存在挑战。活检标本的大小和肿瘤的大小与诊断不一致有显著的相关性。上尿路细胞学检查具有很高的诊断准确性，应与活检互补。
