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Войти в исследования World journal of urology · 2025
Systematic biopsies of the upper urinary tract: a tool to improve the diagnostic accuracy of ureteroscopy and characterization of upper tract urothelial cancer.
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Gallioli Andrea, Basile Giuseppe, Cannoletta Donato, Territo Angelo, Afferi Luca, Izquierdo Paula, Farré Alba, Diéguez Lucía, Diana Pietro, Di Bello Francesco, Mancon Stefano, Gavrilov Pavel, Gaya Josep Maria, Algaba Ferran, Palou Joan, Breda Alberto
Аннотация
PURPOSE: The use of systematic biopsies (SB) in patients with suspicion of upper tract urothelial carcinoma (UTUC) has not been explored. Our objective is to investigate the safety of SB and its impact on the management of UTUC.
METHODS: We included patients who underwent diagnostic ureteroscopy (URS) ± ablation treatment and SB for UTUC at our institution (2015-2022). SB consisted of a minimum of two biopsies in renal pelvis, proximal, medium, and distal ureter. Complications were graded using Clavien-Dindo classification. The impact of SB on oncological outcomes was assessed through Kaplan-Meier curves and Cox regression analysis. Logistic regressions were used to assess predictors of positive SB.
RESULTS: Overall, 50/101 (50%) patients had positive SB. Overall and major complications were 19 (19%) and 4 (4%), respectively. SB detected UTUC in 8/16 (50%) and 18/23 (78%) patients with negative/nondiagnostic and positive target biopsy, respectively. In 8/25 (32%) distal ureteral tumors, SB detected CIS in other upper tract portions. Patients with positive SB were more frequently treated with radical nephroureterectomy (RNU) (2-yr RNU-FS rates 87.7% vs. 53.5%, p < 0.001). SB was an independent predictor of RNU-FS [HR 3.38 (95%CI 1.46-7.80); p = 0.004]. History of CIS [OR 1.26 (95%CI 1.06-1.91), p = 0.04] and tumors ≥ 2 cm [OR 1.32 (95%CI 1.09-1.78), p = 0.04] were independent predictors of SB positivity. Limitations include the single-center, retrospective design of the study.
CONCLUSIONS: The integration of SB into the diagnostic workup of UTUC is safe and feasible. It may drive the treatment choice in high-risk patients.
METHODS: We included patients who underwent diagnostic ureteroscopy (URS) ± ablation treatment and SB for UTUC at our institution (2015-2022). SB consisted of a minimum of two biopsies in renal pelvis, proximal, medium, and distal ureter. Complications were graded using Clavien-Dindo classification. The impact of SB on oncological outcomes was assessed through Kaplan-Meier curves and Cox regression analysis. Logistic regressions were used to assess predictors of positive SB.
RESULTS: Overall, 50/101 (50%) patients had positive SB. Overall and major complications were 19 (19%) and 4 (4%), respectively. SB detected UTUC in 8/16 (50%) and 18/23 (78%) patients with negative/nondiagnostic and positive target biopsy, respectively. In 8/25 (32%) distal ureteral tumors, SB detected CIS in other upper tract portions. Patients with positive SB were more frequently treated with radical nephroureterectomy (RNU) (2-yr RNU-FS rates 87.7% vs. 53.5%, p < 0.001). SB was an independent predictor of RNU-FS [HR 3.38 (95%CI 1.46-7.80); p = 0.004]. History of CIS [OR 1.26 (95%CI 1.06-1.91), p = 0.04] and tumors ≥ 2 cm [OR 1.32 (95%CI 1.09-1.78), p = 0.04] were independent predictors of SB positivity. Limitations include the single-center, retrospective design of the study.
CONCLUSIONS: The integration of SB into the diagnostic workup of UTUC is safe and feasible. It may drive the treatment choice in high-risk patients.