Endoscopic Confirmation in the Diagnosis of Upper Tract Urothelial Cancer: Is It Still a Routine Necessity for all Patients?

Abstract

Objective: We aimed to study if cytology, retrograde pyelography (RP) and URS biopsy are still indicated routinely in patients with a UTUC diagnosis confirmed by CT. Material & Methods: We retrospectively reviewed data from 1996 to 2018, looking for and reviewing all data on cytology, retrograde pyelography, ureteroscopic (URS) biopsy, and CT reports. All were compared to the final histopathological reports. Standard open radical nephroureterectomy procedure, either open or laparoscopically, was performed, and ureterectomy was performed in select cases. Results: There were 275 patients, 87% were male, and the mean age was 59 +11y. Cytology had an overall accuracy of 75%, and retrograde gave positive findings in 94%. Ureteroscopic biopsy was performed in 124 patients with 87% overall accuracy and reached 93% for the ureteral cohort. Complete data on CT was available for 183, with an overall accuracy of 96%. Conclusion: In the diagnostic work-up for, URS biopsy gave a diagnostic accuracy reaching 93%, and CT showed a diagnostic accuracy that reached 96%. In patients with UTUC who planned for radical surgery with poorly functioning kidney, and those who are not candidates for conservative management, the decision can be taken based on CT diagnosis.