Fluoroscopically guided retrograde brush biopsy in the diagnosis of transitional cell carcinoma of the upper urinary tract: results in 45 patients.

This is a retrospective review of 45 patients suspected of having transitional cell carcinoma of the upper urinary tract who underwent fluoroscopically guided retrograde brush biopsy at our institution during a recent 3-year period. All patients evaluated had an abnormal IV urogram or retrograde pyelogram in which the diagnosis of transitional cell carcinoma of the kidney or ureter was suspected or could not be excluded. The results of the brush biopsy were compared with the final diagnosis established at surgery or through clinical and surgical follow-up. Results of the biopsies were classified into five categories: (I) normal transitional epithelium (16 patients), (II) atypical cells (eight patients), (III) dysplastic cells (two patients), (IV) suspicious for malignancy (four patients), and (V) conclusive evidence of malignancy (eight patients). In four additional patients, other miscellaneous diagnoses were made, and in three others the procedure was nondiagnostic. Brush biopsies interpreted as Categories III, IV, and V had a positive predictive value of 100% (14/14) for the diagnosis of transitional cell carcinoma, and biopsies showing atypical cells (Category II) had a positive predictive value of 75% (6/8). Tabulating all diagnostic categories except for normal as a positive diagnosis, the procedure had a sensitivity of 91%, a specificity of 88%, and an accuracy of 89%. No significant complications were encountered. This experience suggests that brush biopsy is a valuable technique in patients suspected of having transitional cell carcinoma.