Ureterorenoscopy for Upper Tract Urothelial Carcinoma: How Often Are We Missing Lesions?

Yamany, Tammer; Batavia, Jason P. Van; Ahn, Jennifer; Shapiro, Edan; Gupta, Mantu

doi:10.1016/j.urology.2014.08.030

Cited by 48 publications

(33 citation statements)

References 23 publications

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“…Urine cytology including fluorescence in situ hybridisation is utilised for its sensitivity (38–97%) and specificity (89–100%); and bladder cystoscopy is a vital test to rule out a concomitant bladder tumor [7]. URS could improve the diagnostic accuracy and prognosis determination with the ability to visualise lesions and perform biopsies, however, studies found that over 25% of patients who underwent URS had missed lesions and approximately half of them had a missed CIS [31]. In addition, URS only has much lower sensitivity of 76% for diagnosing high-grade disease compared with CTU and urine cytology, and has a high rate of undergrading and understaging of UTUC by biopsy [31].…”

Section: Discussionmentioning

confidence: 99%

“…URS could improve the diagnostic accuracy and prognosis determination with the ability to visualise lesions and perform biopsies, however, studies found that over 25% of patients who underwent URS had missed lesions and approximately half of them had a missed CIS [31]. In addition, URS only has much lower sensitivity of 76% for diagnosing high-grade disease compared with CTU and urine cytology, and has a high rate of undergrading and understaging of UTUC by biopsy [31]. However, if surgeons did not perform ureteroscopy, there would be many nephroureterectomies for benign pathology or non-urothelial tumors.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

et al. 2017

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Objective: To assess the impact of diagnostic ureteroscopy (URS) prior to radical nephroureterectomy (RNU) on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). Materials and Methods: A systematic literature search of the Medline, Embase, PubMed, and Cochrane library was performed in August 2017. Cumulative analyses of available hazard ratios (HRs) and their 95% CI were conducted using Stata version 12.0. Results: Eleven studies including 4,057 participants were included, with a total of 1,403 patients diagnosed with IVR during the follow-up period. The pooled HRs of eight studies suggested that diagnostic URS prior to RNU significantly increased the IVR risk after RNU (HR 1.53, 95% CI 1.31–1.77; p < 0.001). However, the preoperative diagnostic URS was not associated with cancer-specific survival (HR 0.72; p = 0.11), metastasis-free survival (HR 1.09; p = 0.60) or overall survival (HR 1.12; p = 0.73). No publication bias was observed (Begg, p = 0.90; Egger, p = 0.71). Conclusions: Regardless, the diagnostic URS prior to RNU might increase the IVR risk in patients with UTUC. As ureteroscopy provides important prognostic and therapeutic value and guides decisions in UTUC, more future studies should be performed to find a novel way to mitigate the potential risk of IVR after RNU, such as chemoprophylaxis after endoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

et al. 2017

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“…Our results showed that 16% (16/97) of UTUCs were missed by ureteroscopic inspection only, and 94% (15/16) of these lesions were CIS. This observation should be interpreted with caution, because the number of patients with CIS only was small in the present study; however, in contrast to the studies by Yamany et al and Gillan et al , we routinely performed in situ cytology of the upper tract, which may account for the smaller number of lesions missed in the present study. These results underline the importance of taking samples during URS, also of the macroscopically tumour‐free upper tract.…”

Section: Discussionmentioning

confidence: 56%

Diagnostic accuracy of computed tomography urography and visual assessment during ureterorenoscopy in upper tract urothelial carcinoma

et al. 2016

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Both MCTU and URS are important tools in the diagnostic evaluation of UTUC although neither of those techniques achieves 100% accuracy. MCTU should be chosen as the radiographical method if there are no contraindications and URS should always be combined with focal cytology and biopsies of suspicious lesions. To enhance diagnostic precision both MCTU and URS with focal samples should be included in the diagnostic procedure. The present results add impact to current diagnostic guidelines.

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“…RCXC can be either CDC or UC of the renal pelvis, and compared with traditionally defined upper tract urothelial carcinomas, RCXC has a locally aggressive behavior, which may limit its spread into the urothelium of the urinary tract (1). However, traditional imaging techniques and rigid ureteroscopic examinations typically fail to detect such lesions in the early stage (6). Although traditional radical nephroureterectomy with bladder cuff excisions remains the gold standard surgical treatment for upper tract urothelial carcinoma (UTUC) (4), this procedure may result in morbidity and loss of nephron units (3).…”

Section: Discussionmentioning

confidence: 99%

Nephron sparing endoscopic treatment for primary carcinoma of the renal calyx: A case report and literature review

Wang

et al. 2016

Molecular and Clinical Oncology

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Abstract. Primary carcinoma of the renal calyx is extremely rare. The present study reported nephron sparing endoscopic treatment for primary carcinoma of the renal calyx. An 81-year-old female presented with a 1-year history of intermittent painless gross hematuria. Computed tomography and X-ray of the urinary tract were unable to definitively identify any lesion. Flexible ureteroscopic examination revealed a tumor with epicenter in the lower calyx of the right kidney, with additional involvement around the calyx. Biopsies were obtained and pathology revealed low-grade urothelial carcinoma. Considering additional co-morbidities, the patient elected to undergo endoscopic management with thulium laser. The present report described the feasibility of flexible ureteroscopic thulium laser resection for the treatment of renal calyx carcinoma.

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Ureterorenoscopy for Upper Tract Urothelial Carcinoma: How Often Are We Missing Lesions?

Cited by 48 publications

References 23 publications

Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

Diagnostic accuracy of computed tomography urography and visual assessment during ureterorenoscopy in upper tract urothelial carcinoma

Nephron sparing endoscopic treatment for primary carcinoma of the renal calyx: A case report and literature review

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