908 EVALUATION OF ADEQUACY OF PATHOLOGIC SPECIMENS USING A NOVEL BACKLOADING URETEROSCOPIC BIOPSY FORCEPS

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy II1 Apr 2010908 EVALUATION OF ADEQUACY OF PATHOLOGIC SPECIMENS USING A NOVEL BACKLOADING URETEROSCOPIC BIOPSY FORCEPS Shaun Wason, Alan Schned, John Seigne, and Vernon Pais Shaun WasonShaun Wason More articles by this author , Alan SchnedAlan Schned More articles by this author , John SeigneJohn Seigne More articles by this author , and Vernon PaisVernon Pais More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Quality of ureteroscopic biopsies may be limited by the small specimen size. Dictated by the working channel of the ureteroscope, biopsy forceps of 3fr have less than 1mm3 of biopsy head volume. Utilizing a backloading design, the BIGopsy™ ureteroscopic biopsy forceps has a biopsy head larger than the working channel of the ureteroscope. Recognizing that small biopsied tissue volume may preclude adequate pathologic evaluation, we sought to assess the adequacy of surgical specimens obtained utilizing the BIGopsy™ forceps. METHODS In accordance with our IRB, patients undergoing nephroureterectomy for suspected upper tract TCC were recruited. Surgical specimens, immediately after extirpation were examined. The most clinically suspicious region to gross examination was alternatively biopsied with a 3fr Piranha® followed by the BIGopsy™ biopsy forceps. These specimens were fixed, stained and evaluated by a single pathologist. Biopsy size and qualitative assessment of specimen adequacy were recorded. Pathologic diagnosis of the biopsy specimens were compared to the final pathologic diagnosis. RESULTS Three nephroureterectomy specimens were evaluated. A total of 6 biopsies were obtained from the Piranha® and 5 biopsies from the BIGopsy™. Biopsy size from the Piranha® ranged from 1 to 8mm2, while those from the BIGopsy™ ranged from 6 to 80mm2. Average biopsy size from the Piranha® was 3.5 +/- 2.8mm2 while the average biopsy size from the BIGopsy™ was 31.2 +/-34.6mm2. In 2 of 3 nephroureterectomy specimens, final diagnosis was high grade papillary urothelial carcinoma in accordance with both the Piranha® and BIGopsy™ specimens. In the third specimen, the final diagnosis was benign polypoid/papillary pyelitis consistent with only the BIGopsy™ specimen, while the Piranha® specimen was suspicious for a low grade papillary lesion. Subjectively, the BIGopsy™ specimens revealed less distortion and fragmentation and were easier to interpret by the pathologist. Smooth muscle was contained in 1 of 3 BIGopsy™ specimens and in none of the Piranha® specimens. CONCLUSIONS The BIGopsy™ backloading biopsy forceps allows removal of ureteral and renal pelvic tissue larger than the standard 3fr biopsy forceps. In all 3 cases, the diagnosis based upon the BIGopsy™ biopsy agreed with the final pathologic report, one of which was pathologically misassigned as malignant by the smaller 3fr Piranha® biopsy forceps specimen. Improved biopsy quality may translate into improved ability to diagnose ureteral and renal pelvic mucosal lesions endoscopically. Lebanon, NH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e354-e355 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shaun Wason More articles by this author Alan Schned More articles by this author John Seigne More articles by this author Vernon Pais More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...