High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection

Thomas Clements, Jamie C. Messer, John D. Terrell, Michael P. Herman, Casey K. Ng, Douglas S. Scherr, Benjamin Scoll, Stephen A. Boorjian, Robert G. Uzzo, Mark Wille, Scott E. Eggener, Steven M. Lucas, Yair Lotan, Shahrokh F. Shariat, Jay D. Raman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


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), or muscle invasive (MI; ≥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.

Original languageEnglish (US)
Pages (from-to)398-402
Number of pages5
JournalJournal of Endourology
Issue number4
StatePublished - Apr 1 2012

ASJC Scopus subject areas

  • Urology

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