The role of urinary cytology when diagnostic workup is suspicious for upper tract urothelial carcinoma but tumour biopsy is nonconfirmatory

Introduction: We sought to determine the value of obtaining preoperative urinary cytology when diagnostic workup of an upper tract mass is suspicious for upper tract urothelial carcinoma (UTUC), but biopsy fails to confirm the diagnosis.Methods: Using billing code data, 239 patients were identified as having undergone radical nephroureterectomy (RNU) by 16 urologists from September 29, 1998 to July 31, 2015. Of this group, 19 adult patients had a presumed preoperative diagnosis of UTUC in a native kidney, at least three months of followup, no history of concurrent radical cystectomy with RNU, and negative/non-diagnostic tissue biopsy. These patients were divided into three groups: Group A had no urinary cytology taken (n=6); Group B had upper and/or lower tract cytology performed with neither positive nor atypical (n=7); Group C had upper and/or lower tract cytology performed with at least one positive or atypical (n=6).Results: Demographic information and diagnostic workup was similar between the groups, although Group A had more patients with a history of prior radical cystectomy for bladder cancer (p=0.02). One patient in Group B had benign tissue on final pathology. All patients in Groups A and C had malignancy on final pathology and overall, the three groups had similar rates of malignancy.Conclusions: When a composite of clinical findings suggest UTUC, performing urinary cytology may not be necessary. A negative result in this setting should not be used to rule out UTUC, as this is often discordant with final pathology. A positive cytology result may help solidify the diagnosis when other findings are less clear.

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Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

BMC Cancer ◽

10.1186/s12885-020-07623-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Wen Liu ◽

Zhankun Wang ◽

Shuai Liu ◽

Yu Yao ◽

Yong Liu ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Urothelial Carcinoma ◽

Logistic Regression Analysis ◽

Tumor Grade ◽

Urine Cytology ◽

Upper Tract Urothelial Carcinoma ◽

Urinary Cytology ◽

Upper Tract ◽

The Impact

Abstract Background Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU). Methods Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade. Results Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52). Conclusion Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

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A review of urinary cytology in the setting of upper tract urothelial carcinoma

Journal of the American Society of Cytopathology ◽

10.1016/j.jasc.2020.06.011 ◽

2020 ◽

Author(s):

M. Lisa Zhang ◽

Christopher J. VandenBussche ◽

Jen-Fan Hang ◽

Yurina Miki ◽

Patrick J. McIntire ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Urinary Cytology ◽

Upper Tract

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The Diagnostic Utility of Urinary Cytology in Detecting Upper Tract Urothelial Carcinoma

American Journal of Clinical Pathology ◽

10.1093/ajcp/138.suppl1.029 ◽

2012 ◽

Vol 138 (suppl 1) ◽

pp. A029-A029

Author(s):

Huiying He ◽

Ming Zhou ◽

Cristina Magi-Galluzzi ◽

Longwen Chen

Keyword(s):

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Urinary Cytology ◽

Diagnostic Utility ◽

Upper Tract

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Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

10.21203/rs.3.rs-17463/v5 ◽

2020 ◽

Author(s):

Wen Liu ◽

Zhankun Wang ◽

Shuai Liu ◽

Yu Yao ◽

Yong Liu ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Urothelial Carcinoma ◽

Logistic Regression Analysis ◽

Tumor Grade ◽

Urine Cytology ◽

Upper Tract Urothelial Carcinoma ◽

Urinary Cytology ◽

Upper Tract ◽

The Impact

Abstract Background: Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU).Methods: Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade.Results: Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52).Conclusion: Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

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Correlation of Urinary Cytology Classified According to The Paris System (TPS) for Reporting Urinary Cytology in Patients with Histologically Confirmed Upper Tract Urothelial Carcinoma

Journal of the American Society of Cytopathology ◽

10.1016/j.jasc.2020.07.030 ◽

2020 ◽

Vol 9 (6) ◽

pp. S15

Author(s):

Huili Li ◽

Catherine Abendroth

Keyword(s):

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Urinary Cytology ◽

Upper Tract

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Endoscopic exploration directly impacts clinical decision making in the management of patients with suspected upper tract urothelial carcinoma following radical cystectomy

European Urology ◽

10.1016/s0302-2838(21)01173-8 ◽

2021 ◽

Vol 79 ◽

pp. S1104

Author(s):

J. Aumatell Ovide ◽

J. Huguet Pérez ◽

J.D. Subiela ◽

A. Mercadé Sánchez ◽

J. Balañà Lucena ◽

...

Keyword(s):

Decision Making ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Clinical Decision Making ◽

Clinical Decision ◽

Upper Tract Urothelial Carcinoma ◽

Upper Tract

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A Diagnostic Nomogram of Pathologic Grade for Preoperative Risk Stratification in Upper Tract Urothelial Carcinoma

Clinical Medicine Insights Oncology ◽

10.1177/1179554920927662 ◽

2020 ◽

Vol 14 ◽

pp. 117955492092766

Author(s):

Runzhuo Ma ◽

Haizhui Xia ◽

Min Qiu ◽

Liyuan Tao ◽

Min Lu ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Tumor Grade ◽

Upper Tract Urothelial Carcinoma ◽

Calibration Plot ◽

Urinary Cytology ◽

Low Grade ◽

High Grade ◽

Pathological Grade ◽

Upper Tract ◽

Better Than

Background: To develop a novel nomogram to improve the preoperative diagnosis of pathological grade of upper tract urothelial carcinoma (UTUC). Methods: Retrospective study was conducted with 245 patients with UTUC treated by radical nephroureterectomy from 2002 to 2016. Of the cohort, 57.6% received ureteroscopic (URS) biopsy and 35.9% received urine cytology examination. Preoperative clinical characteristics and examination results were collected. Final pathological grade was diagnosed by postoperative pathology. Univariable and multivariable binary logistic regressions were applied to establish a preoperative predictive model for tumor grade, and significant factors were included in the nomogram. The area under curve (AUC) was used to show the predictive efficacy, and the calibration plot was drawn for validation. Results: Of the 245 patients, 72.7% were diagnosed with pathological high-grade disease. Age (odds ratio [OR] = 1.03, P = .039), sessile (OR = 3.86, P = .021), positive urinary cytology (OR = 6.87, P = .035), and biopsy high-grade result (OR = 10.85, P < .001) were independent predictors for pathological high-grade disease. The predictive nomogram containing these factors achieved an AUC of 0.78, which was significantly better than URS biopsy alone (AUC = 0.62, P = .003) in the whole cohort. In the URS biopsy subgroup, the nomogram achieved an AUC of 0.79, better than biopsy alone (AUC = 0.76), but was not statistically significant ( P = .431). When the cutoff value of the nomogram was set at 0.64, the sensitivity of detecting a high-grade lesion versus low-grade lesion was 80.3%, better than that of URS biopsy alone (sensitivity = 65.7%). Conclusions: Advanced age, sessile, positive urinary cytology, and biopsy high-grade were independent predictors of pathological high-grade disease in patients with UTUC. A nomogram containing these factors can improve diagnostic accuracy, potentially reducing the risk of “undergrading” by URS biopsy.

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