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21.11.2023 | Topic Paper

Positioning the role of urine cytology within the diagnostic pathway for UTUC: supportive but inconclusive

verfasst von: Orlane J. A. Figaroa, Nora Hendriks, Guido M. Kamphuis, R. Jeroen A. van Moorselaar, Adriaan D. Bins, Joyce Baard

Erschienen in: World Journal of Urology | Ausgabe 12/2023

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Abstract

Purpose

With the introduction of kidney-sparing surgery (KSS) for low-risk Upper Tract Urothelial Carcinoma (UTUC), correct risk-stratification has become crucial. High-grade cytology is one of the decisive variables to stratify a tumor as high-risk. To position the role of urine cytology in the diagnostic pathway of UTUC patients, we evaluated the accuracy of urine cytology by comparing the outcomes with histopathology.

Method

Patients with UTUC evaluated between 2010 and 2020, and diagnosed by imaging, cytology and histopathology were selected. Descriptive statistics were used to compare cytology with histopathological outcomes using crosstabs. Clinical performance characteristics of cytology were determined for the presence of a malignancy.

Results

This study included 176 patients with confirmed histopathological UTUC. Concordance between cytology and biopsy results was found in 14.8% of low-grade tumors and 16.8% of high-grade tumors. Comparing cytology with radical nephroureterectomy (RNU) specimens revealed concordance rates of 1.6% for low-grade tumors and 22.9% for high-grade tumors. Notably, 51.1% of urine cytology results were false negative. Sensitivity for detecting high-grade and low-grade tumors with a positive urine cytology was 56.6% and 52.6%, respectively, with specificities of 54.8% and 37.2%.

Conclusion

In the current study, cytology appears to exhibit limited reliability when used as a sole diagnostic tool for assessing tumor grade and consequently risk stratification. It is imperative to recognize these limitations, optimize urine sampling techniques, and leverage a combination of diverse diagnostic methods for the most effective and individualized treatment decision-making.

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Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ, Cancer Statistics (2009) Both sexes female both sexes estimated deaths. CA Cancer J Clin 59(4):1–25

Rouprêt, M., et al. EAU Guidelines on Urothelial Carcinomas of the Upper Urinary Tract 2023. Edn. presented at the 38th EAU Annual Congress Milan. European Association of Urology Guidelines Office Arnhem, The Netherlands.

Seisen T, Peyronnet B, Dominguez-Escrig JL, Bruins HM, Yuan CY, Babjuk M et al (2016) Oncologic outcomes of Kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma: a systematic review by the EAU Non-muscle invasive bladder cancer guidelines panel. Eur Urol 70(6):1052–1068CrossRefPubMed

Xu AD, Ng CS, Kamat A, Grossman HB, Dinney C, Sandler CM (2010) Significance of upper urinary tract urothelial thickening and filling defect seen on MDCT urography in patients with a history of urothelial neoplasms. Am J Roentgenol 195(4):959–965CrossRef

Grahn A, Melle-Hannah M, Malm C, Jäderling F, Radecka E, Beckman M et al (2017) Diagnostic accuracy of computed tomography urography and visual assessment during ureterorenoscopy in upper tract urothelial carcinoma. BJU Int 119(2):289–297CrossRefPubMed

Cowan NC, Turney BW, Taylor NJ, McCarthy CL, Crew JP (2007) Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour. BJU Int 99(6):1363–1370. https://doi.org/10.1111/j.1464-410X.2007.06766.xCrossRefPubMed

Fritz GA, Schoellnast H, Deutschmann HA, Quehenberger F, Tillich M (2006) Multiphasic multidetector-row CT [MDCT] in detection and staging of transitional cell carcinomas of the upper urinary tract. Eur Radiol 16(6):1244–1252CrossRefPubMed

Coleman JA, Clark PE, Bixler BR et al (2023) Diagnosis and management of non-metastatic upper tract urothelial carcinoma: AUA/SUO guideline. J Urol 209(6):1071–1081CrossRefPubMed

Gontero, P., et al. Guidelines on Non-muscle-invasive Bladder Cancer [T1, T1 and CIS], in EAU Guidelines, Edn. presented at the 38th EAU Annual Congress Milan. 2023, EAU Guidelines Office, Arnhem, The Netherlands.

10.

Yafi FA, Brimo F, Steinberg J, Aprikian AG, Tanguay S, Kassouf W (2015) Prospective analysis of sensitivity and specificity of urinary cytology and other urinary biomarkers for bladder cancer. Urol Oncol Semin Orig Investig 33(2):66.e25-66.e31

11.

Têtu B. Diagnosis of urothelial carcinoma from urine. Mod Pathol. 2009;22[October 2008]:S53–9.

12.

Messer J, Shariat SF, Brien JC, Herman MP, Ng CK, Scherr DS et al (2011) Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma. BJU Int 108(5):701–705CrossRefPubMed

13.

Lodde M, Mian C, Wiener H, Haitel A, Pycha A, Marberger M (2001) Detection of upper urinary tract transitional cell carcinoma with ImmunoCyt: A preliminary report. Urology 58(3):362–366CrossRefPubMed

14.

Dev HS, Poo S, Armitage J, Wiseman O, Shah N, Al-Hayek S (2017) Investigating upper urinary tract urothelial carcinomas: a single-centre 10-year experience. World J Urol 35(1):131–138. https://doi.org/10.1007/s00345-016-1820-8. (Epub 2016 Apr 29 PMID: 27129575)CrossRefPubMed

15.

Epstein JI, Eble JN, Sauter G, Sesterhenn IA, (2004). World Health Organization Classification of tumors: pathology and genetics of tumours of the urinary system and male genital organs World Health Organization Classification of tumors: pathology and genetics of tumours of the urinary system and male genital organs.

16.

Baard J, Shariat SF, Roupret M et al (2022) Adherence to guideline recommendations in the management of upper tract urothelial carcinoma: an analysis of the CROES–UTUC registry. World J Urol 40:2755–2763. https://doi.org/10.1007/s00345-022-04168-zCrossRefPubMed

17.

Potretzke AM, Knight BA, Vetter JM, Anderson BG, Hardi AC, Bhayani SB, Figenshau RS (2016) Diagnostic utility of selective upper tract urinary cytology: a systematic review and meta-analysis of the literature. Urology 96:35–43. https://doi.org/10.1016/j.urology.2016.04.030. (Epub 2016 May 2)CrossRefPubMed

18.

Freund JE, Duivenvoorden MJC., Sikma BT, Vernooij RWM, Savci-Heijink CD, Legemate JD, de Reijke TM (2020) The Diagnostic yield and concordance of ureterorenoscopic biopsies for grading of upper tract urothelial carcinoma: a dutch nationwide analysis. J Endourology. https://doi.org/10.1089/end.2020.0246CrossRef

19.

Zhang ML, Rosenthal DL, VandenBussche CJ (2017) Upper urinary tract washings outperform voided urine specimens to detect upper tract high-grade urothelial carcinoma. Diagn Cytopathol 45(8):700–704CrossRefPubMed

20.

Bibbo M, Gill WB, Harris MJ, Thomsen SWG (1974) Retrograde brushing as a diagnostic procedure of ureteral, renal pelvic and renal calyceal lesions. a preliminary report. Acta Cytol 18(2):137–41PubMed

21.

Malm C, Grahn A, Jaremko G, Tribukait B, Brehmer M (2017) Diagnostic accuracy of upper tract urothelial carcinoma: how samples are collected matters. Scand J Urol 51(2):137–145CrossRefPubMed

22.

Hentschel AE, van der Toom EE, Vis AN, Ket JCF, Bosschieter J, Heymans MW, van Moorselaar RJA, Steenbergen RDM, Nieuwenhuijzen JA (2021) A systematic review on mutation markers for bladder cancer diagnosis in urine. BJU Int 127(1):12–27. https://doi.org/10.1111/bju.15137. (Epub 2020 Aug 16)CrossRefPubMed

23.

Territo A, Gallioli A, Diana P, Boissier R, Fontana M, Gaya JM, Sanguedolce F, Calderón J, Piana A, Fontanet S, Algaba F, Palou J, Breda A (2022) DNA Methylation urine biomarkers test in the diagnosis of upper tract urothelial carcinoma: results from a single-center prospective clinical trial. J Urol 208(3):570–579. https://doi.org/10.1097/JU.0000000000002748. (Epub 2022 May 12)CrossRefPubMed

24.

Ghoreifi A, Seyedian SL, Piatti P, Chew YC, Jara B, Sanossian L, Bhasin JM, Yamada T, Fuchs G, Bhanvadia S, Sotelo R, Hung A, Aron M, Desai M, Gill I, Daneshmand S, Liang G, Djaladat H. (1974)A Urine-based DNA Methylation Marker Test to Detect Upper Tract Urothelial Carcinoma: A Prospective Cohort Study. J Urol

25.

Skolarikos A, Griffiths TR, Powell PH, Thomas DJ, Neal DE, Kelly JD (2003) Cytologic analysis of ureteral washings is informative in patients with grade 2 upper tract TCC considering endoscopic treatment. Urology 61(6):1146–1150. https://doi.org/10.1016/s0090-4295[03]00026-8CrossRefPubMed

26.

Renshaw AA (2006) Comparison of ureteral washing and biopsy specimens in the community setting. Cancer 108(1):45–48. https://doi.org/10.1002/cncr.21456. (PMID: 16302250)CrossRefPubMed

27.

Zhao Y, Deng FM, Melamed J, Huang WC, Huang H, Ren Q (2021) Diagnostic role of urine cytology and ureteroscopic biopsies in detection of high grade upper tract urothelial carcinoma. Am J Clin Exp Urol 9(3):221–228PubMedPubMedCentral

Titel: Positioning the role of urine cytology within the diagnostic pathway for UTUC: supportive but inconclusive
verfasst von: Orlane J. A. Figaroa
Nora Hendriks
Guido M. Kamphuis
R. Jeroen A. van Moorselaar
Adriaan D. Bins
Joyce Baard
Publikationsdatum: 21.11.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 12/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04689-1

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Positioning the role of urine cytology within the diagnostic pathway for UTUC: supportive but inconclusive