Abstract：
OBJECTIVE: We studied the diagnostic accuracy and discordance of upper tract urothelial carcinoma (UTUC) by comparing biopsy and urinary cytology with matched nephroureterectomy specimens.
METHODS: Sixty-nine patients with UTUC without neoadjuvant treatment were retrospectively identified who had matched biopsy and nephroureterectomy specimens. Twenty patients had concurrent upper tract cytology. H&E and cytology slides were re-reviewed. Statistical analysis was performed.
RESULTS: Patients included 48 men and 21 women with a mean age of 69 years. A concordant grade between biopsy and surgical specimen was present in 49 (71%) patients. The mean size of biopsy specimens in the discordant group was significantly smaller than that in the concordant group. Invasion was evaluated in 48 biopsy cases that had adequate subepithelial tissue, and 33 of them were diagnosed with concordant invasion status. Mean tumor size in both tumor grade and invasion discordant groups was significantly larger than that in the concordant group. High-grade urothelial carcinoma was detected in 84% of cases using urinary cytology.
CONCLUSIONS: Our study demonstrates the diagnostic challenges of UTUC on small biopsy specimens. Biopsy specimen size and tumor size are significantly associated with the diagnostic discordance. Upper tract cytology showed high diagnostic accuracy and should be complementary to the biopsy.
METHODS: Sixty-nine patients with UTUC without neoadjuvant treatment were retrospectively identified who had matched biopsy and nephroureterectomy specimens. Twenty patients had concurrent upper tract cytology. H&E and cytology slides were re-reviewed. Statistical analysis was performed.
RESULTS: Patients included 48 men and 21 women with a mean age of 69 years. A concordant grade between biopsy and surgical specimen was present in 49 (71%) patients. The mean size of biopsy specimens in the discordant group was significantly smaller than that in the concordant group. Invasion was evaluated in 48 biopsy cases that had adequate subepithelial tissue, and 33 of them were diagnosed with concordant invasion status. Mean tumor size in both tumor grade and invasion discordant groups was significantly larger than that in the concordant group. High-grade urothelial carcinoma was detected in 84% of cases using urinary cytology.
CONCLUSIONS: Our study demonstrates the diagnostic challenges of UTUC on small biopsy specimens. Biopsy specimen size and tumor size are significantly associated with the diagnostic discordance. Upper tract cytology showed high diagnostic accuracy and should be complementary to the biopsy.
摘要：
目的：我们通过比较活检和尿细胞学检查与匹配的肾输尿管切除术标本，研究了上尿路尿路上皮癌（UTUC）的诊断准确性和不一致性。
方法：对69例未接受新辅助治疗的UTUC患者进行回顾性分析，这些患者的活检标本与肾输尿管切除术标本相匹配。20例患者同时进行了上尿路细胞学检查。重新审查H&E和细胞学切片。进行统计分析。
结果：患者包括48名男性和21名女性，平均年龄为69岁。49例（71％）患者的活检标本和手术标本之间的等级一致。不一致组活检标本的平均大小明显小于一致组。在48例具有足够上皮下组织的活检病例中评估了侵袭，其中33例被诊断为一致的入侵状态。肿瘤分级和侵袭不一致组的平均肿瘤大小明显大于一致组。84％的病例使用尿细胞学检查检测到高度尿路上皮癌。
结论：我们的研究证明了UTUC对小活检标本的诊断挑战。活检标本大小和肿瘤大小与诊断不一致显着相关。上消化道细胞学检查显示出较高的诊断准确性，应与活检互补。
方法：对69例未接受新辅助治疗的UTUC患者进行回顾性分析，这些患者的活检标本与肾输尿管切除术标本相匹配。20例患者同时进行了上尿路细胞学检查。重新审查H&E和细胞学切片。进行统计分析。
结果：患者包括48名男性和21名女性，平均年龄为69岁。49例（71％）患者的活检标本和手术标本之间的等级一致。不一致组活检标本的平均大小明显小于一致组。在48例具有足够上皮下组织的活检病例中评估了侵袭，其中33例被诊断为一致的入侵状态。肿瘤分级和侵袭不一致组的平均肿瘤大小明显大于一致组。84％的病例使用尿细胞学检查检测到高度尿路上皮癌。
结论：我们的研究证明了UTUC对小活检标本的诊断挑战。活检标本大小和肿瘤大小与诊断不一致显着相关。上消化道细胞学检查显示出较高的诊断准确性，应与活检互补。
