The implementation of systematic biopsies in the endoscopic management of upper tract urothelial cancer

You have accessJournal of UrologyCME1 Apr 2023MP69-14 THE IMPLEMENTATION OF SYSTEMATIC BIOPSIES IN THE ENDOSCOPIC MANAGEMENT OF UPPER TRACT UROTHELIAL CANCER Andrea Gallioli, Angelo Territo, Basile Giuseppe, Pietro Diana, Paolo Verri, Francesco Sanguedolce, Josep Maria Gaya, Pavel Gavrilov, Alessandro Uleri, Sofia Fontanet, Paula Izquierdo, Jordi Huguet, Ferran Algaba, Joan Palou, and Alberto Breda Andrea GallioliAndrea Gallioli More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Basile GiuseppeBasile Giuseppe More articles by this author , Pietro DianaPietro Diana More articles by this author , Paolo VerriPaolo Verri More articles by this author , Francesco SanguedolceFrancesco Sanguedolce More articles by this author , Josep Maria GayaJosep Maria Gaya More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Sofia FontanetSofia Fontanet More articles by this author , Paula IzquierdoPaula Izquierdo More articles by this author , Jordi HuguetJordi Huguet More articles by this author , Ferran AlgabaFerran Algaba More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Diagnosis of upper tract urothelial cancer (UTUC) is crucial. In this regard, uretheral systematic biopsies (USB) have never been considered. We aim to investigate the safety and usefulness of USB in the diagnosis of UTUC and its impact on disease management. METHODS: We relied on a prospectively maintained database of patients who underwent diagnostic ureteroscopy (URS) for UTUC between 2015-21. USB included at least 2 biopsies in each UT portion: pelvis, proximal, medium, and distal ureter. Perioperative complications were graded using the Clavien-Dindo (CD) classification. We assessed the surgical safety and diagnostic impact of USB and estimated the 2-yr nephroureterectomy free-survival (NFU-FS) according to USB results. Then, we investigated the added value of USB over high-risk tumor variables according to EAU prognostic model. Finally, uni and multivariable logistic regression (MLR) analyses investigated preoperative predictors of positive USB. RESULTS: Overall, 91/360 (25.3%) patients underwent USB. Compared to patients who did not undergo USB, USB did not increase the risk of perioperative and major (CD >3a) complications, nor the risk of readmission (all p>0.05). USB was positive in 43 (47.25%) cases, negative in 30 (33%) patients. 58/300 (19.3%) biopsies were not diagnostic. In 36 (39.5%) patients both USB and biopsy of a suspicious lesion were performed. In 7 (19.4%) cases, USB outperformed the biopsy of the lesion in detecting UTUC. 11 (12%) patients were diagnosed with a distal ureter tumor. In 5 (45.4%) cases USB detected UTUC in other upper tract portions. The 2-yr NFU-FS rates were 87.7% (95CI%: 78.1-98.5) vs 53% (95%CI: 39.4-71.2) (p=0.001) for negative vs positive USB patients. At Cox-regression model accounting for predefined variables, patients with positive USB (vs. negative) had a higher risk of being treated with NFU [Hazard ratio: 3.38, 95%CI: 1.46-7.80, p=0.004)]. At MLR analysis, after adjusting for age, pre-operative positive cytology, smoking status, previous bladder cancer and previous UTUC, patients with negative pre-operative CT scan had a higher probability of having a positive USB (Odds ratio: 8.36, 95%CI: 1.57-71.18, p=0.02). CONCLUSIONS: USB is a safe procedure and detected a non-visible tumor at URS in one over five patients. Positive USB increases the risk of radical treatment and possibly changes the treatment algorithm in almost 50% of the patients with distal ureteral tumor candidates to conservative management. When UTUC is suspected, patients with preoperative negative CT scan may benefit the most from USB. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e969 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Gallioli More articles by this author Angelo Territo More articles by this author Basile Giuseppe More articles by this author Pietro Diana More articles by this author Paolo Verri More articles by this author Francesco Sanguedolce More articles by this author Josep Maria Gaya More articles by this author Pavel Gavrilov More articles by this author Alessandro Uleri More articles by this author Sofia Fontanet More articles by this author Paula Izquierdo More articles by this author Jordi Huguet More articles by this author Ferran Algaba More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...