泌尿道上皮癌中輸尿管鏡切片與最終病理報告升級之高發生率：單一區域醫院經驗

郭炫廷、楊景偉、黃家倫、謝啟誠、王曉暹、陳光國、張心湜 與 蔡昇翰

振興醫療財團法人振興醫院泌尿部

High Incidence of Upgrading between Ureterorenoscopic Biopsy and Final Pathology in Upper Tract Urothelial Carcinoma: A Single Regional Hospital Experience

Hsuan-Ting Kuo, Chin-Wei Yang, Chia-Lun Huang, Chi-Cheng Hsieh, Hsiao-Hsian Wang, Kuang-Kuo Chen, Luke S. Chang, and Sheng-Han Tsai

Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan

Purpose: Ureterorenoscopic (URS) biopsy is a frequently used technique for diagnosing upper tract urothelial carcinoma (UTUC). However, there is often a discrepancy between the preoperative biopsy result and the final pathology report, particularly when low-grade tumors are upgraded to higher grades. Our study aims to investigate the pathological upgrading incidence of UTUC which might lead to potential tumor underestimation, and its relative parameters.

Materials and Methods: We conducted a retrospective analysis on a cohort of 84 patients diagnosed with UTUC who underwent pre-operative URS biopsy followed by radical nephroureterectomy at our hospital between 2013 and 2023. Pathological upgrading is defined as “low grade or papillary urothelial neoplasm of low malignant potential (PUNLMP) specimen obtained by URS biopsy and presented with high grade tumor in the final pathology.” The primary outcome of our study is to evaluate the incidence of pathological upgrading, and the relative parameters were listed and analyzed.

Results: We enrolled a total of 55 patients with available data of both pre-operative URS biopsy and radical surgery pathology. Among all tumors, renal pelvic-calyceal tumors accounted for 43.6%, while tumors in the upper, middle, and lower third ureter accounted for 21.8%, 18.2%, and 16.4%, respectively. The overall rate of pathological upstaging was 84.6% for low-grade or PUNLMP tumors, of which 46.2% originated from the renal pelvis-calyces and 23.1% from the upper third of the ureter.

Conclusion: Our study highlights the importance of considering the location of UTUC within the collecting system when interpreting pre-operative URS biopsy results. We found a high incidence of pathological upgrading in low-grade tumors, especially those originating from the renal pelvis-calyces and upper third of the ureter. These findings suggest that caution should be taken when relying solely on URS biopsy results for treatment decisions, and that the location of the tumor should also  be taken into account in the clinical management of UTUC.