High-Grade Ureteroscopic Biopsy Is Associated with Advanced Pathology of Upper-Tract Urothelial Carcinoma Tumors at Definitive Surgical Resection
High-Grade Ureteroscopic Biopsy Is Associated with Advanced Pathology of Upper-Tract Urothelial Carcinoma Tumors at Definitive Surgical Resection
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DOI：
10.1089/end.2011.0426
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发表时间：
2012-04-01
影响因子：
2.7
通讯作者：
Raman, Jay D.
中科院分区：
文献类型：
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作者：
Clements, Thomas;Messer, Jamie C.;Raman, Jay D.
背景和目的：准确评估上尿路上皮癌（UTUC）的病理学可以指导内镜治疗与摘除治疗的使用。我们提出了一个多机构队列的患者与UTUC谁接受手术切除术的特点与输尿管镜（URS）活检功能与最终pathological results.Patients和方法的关联：URS活检数据可在238例患者接受手术切除的UTUC。使用活检刷套件、机械活检装置或篮进行活检。分期为刷拭阳性，非肌肉浸润性（= pT（2））。结果：在URS活检中，88/238（37%）例患者有阳性刷检，140（59%）例诊断为非MI，10（4%）例有MI疾病。活检结果显示140例（59%）为低度癌症，98例（41%）为高度癌症。手术切除时的病理学评价显示140例（59%）患者为非MI肿瘤，98例（41%）为MI，150例（63%）为高级别疾病。在单变量分析中，高URS活检分级与手术时高分级（阳性预测值[PPV] 92%，P < 0.0001）和MI（PPV 60%，P < 0.0001）UTUC相关。然而，URS活检分期与手术病理分级相关（P = 0.005），而与MI疾病无关（P = 0.16）。在多变量分析中，高URS分级，而非活检分期，与高最终病理分级相关（风险比[HR] 16.6，95%置信区间[CI] 7.0-39.5，P < 0.0001）和MI UTUC结论：高URS活检分级与肿瘤病理学不良反应有关，而与肿瘤分期无关。这些信息可能对UTUC的风险分层和内镜治疗与手术切除的适当选择起到有价值的作用。
Background and Purpose: Accurate assessment of upper-tract urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results.Patients and Methods: URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (= pT(2)). Grade was classified as low or high.Results: On URS biopsy, 88/238 (37%) patients had a positive brush, 140 (59%) had a diagnosis of non-MI, and 10 (4%) had MI disease. Biopsy results showed low-grade cancer in 140 (59%) and high-grade cancer in 98 (41%). Pathologic evaluation at surgical resection demonstrated non-MI tumors in 140 (59%) patients, MI in 98 (41%), and high-grade disease in 150 (63%). On univariate analysis, high URS biopsy grade was associated with high-grade (positive predictive value [PPV] 92%, P < 0.0001) and MI (PPV 60%, P < 0.0001) UTUC at surgery. URS biopsy stage, however, was associated with surgical pathology grade (P = 0.005), but not MI (P = 0.16) disease. On multivariate analysis, high URS grade, but not biopsy stage, was associated with high final pathology grade (hazard ratio [HR] 16.6, 95% confidence interval [CI] 7.0-39.5, P < 0.0001) and MI UTUC (HR 3.6, 95% CI 2.1-6.8, P < 0.0001).Conclusion: High URS biopsy grade, but not stage, is associated with adverse tumor pathology. This information may play a valuable role for risk stratification and in the appropriate selection of endoscopic management vs surgical extirpation for UTUC.