Introduction & Objective :
Radical nephroureterectomy (RNU) with an ipsilateral bladder cuff excision is the gold standard treatment for UTUC. Nephron-sparing surgery (NSS) is traditionally reserved for patients with an imperative indication for renal preservation. An ideal method to procure adequate tissue fot UTUC diagnosis has not yet been described. The principal aim of this study is to analyze the diagnostic yield of three different biopsy devices with a view to establishing whether any one of them shows superiority. Another aim is to evaluate the association between ureteroscopic biopsy grading and final UTUC pathology results when distal ureterectomy or RNU was carried out.
Biopsies were taken using three different devices: 3F biopsy forceps, 6F BIGopsy® Backloading biopsy forceps, and 2.2F Nitinol Basket. Data were prospectively collected and retrospectively analyzed. The ability of each biopsy device to obtain an adequate pathology specimen was evaluated using univariate and multivariate binary logistic regression analysis. When possible, UTUC lesions were treated using holmium laser ablation or monopolar coagulation.
Data on 85 patients (70 males and 15 females) were reported. The mean (SD) age was 71.32 (9.28) years. In total, 112 diagnostic and therapeutic URS and f-URS procedures were performed. A total of 302 biopsies were taken, and in 236 (78.2%) cases the pathologist was able to make a diagnosis of the specimen received. 140 cases of UTUC were found: 75 low grade, 50 high grade, and 15 carcinoma in situ. In 66 cases (21.8%) the biopsy specimens were inadequate for an accurate diagnosis; of these, 55 (83.3%) were taken using 3F forceps and 11 (16.7%) using BIGopsy forceps. No cases of inadequate specimen arose when using the 2.2F Nitinol Basket. Among 28 patients who underwent distal ureterectomy or RNU, the tumor was upgraded on final pathology to high grade in 9 cases (32%), while in 19 (68%) cases the tumor grading was confirmed.
Conclusions : In comparison to 3F forceps, the BIGopsy forceps are superior in obtaining sufficient specimen for pathologic examination. The 2.2F Nitinol basket is useful in large tumors to permit debulking of the lesion while achieving a final pathology diagnosis in 100% of the cases. The biopsy specimen has to be taken with large forceps or Nitinol Baskets whenever possible, in order to obtain the highest possible accuracy in grading the tumor. For tumorbetween URS biopsy grade and final pathology after distal ureterectomy or RNU, but almost 30% of the tumors > 2cm are misdiagnosed by just the CT and biopsy.
Angelo Territo– licata, Sicilia, Italy
Alberto Breda– Barcelona, Catalonia, Spain
Giuseppe Basile– Reggio Calabria, Calabria, Italy
Jose Subiela– Barcelona, Catalonia, Spain
Jose maria Gaya– Barcelona, Catalonia, Spain
Joan Palou– Chairman of Urology Departmentt at Fundacio Puigvert. Chair of the European School of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain, Barcelona, Catalonia, Spain