S&T-39 CONCORDANCE OF URETEROSCOPIC BIOPSY GRADE TO RADICAL NEPHROURETERECTOMY GRADE AND STAGE BASED ON THE 1973 AND 2004 WHO CLASSIFICATION SYSTEMS FOR UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-39 CONCORDANCE OF URETEROSCOPIC BIOPSY GRADE TO RADICAL NEPHROURETERECTOMY GRADE AND STAGE BASED ON THE 1973 AND 2004 WHO CLASSIFICATION SYSTEMS FOR UPPER TRACT UROTHELIAL CARCINOMA Ryuta Tanimoto, Scott G Hubosky, Kelly A Healy, Ruth Birbe, Marluce Bibbo, and Demetrius H Bagley Ryuta TanimotoRyuta Tanimoto More articles by this author , Scott G HuboskyScott G Hubosky More articles by this author , Kelly A HealyKelly A Healy More articles by this author , Ruth BirbeRuth Birbe More articles by this author , Marluce BibboMarluce Bibbo More articles by this author , and Demetrius H BagleyDemetrius H Bagley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2868AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Upper tract urothelial carcinoma (UTUC) is relatively rare with diagnostic and treatment strategies usually originating from long term single institutional experiences which report pathological findings using the antiquated 1973 WHO classification system for grading urothelial carcinoma. Given the challenges with preoperative staging of UTUC, ureteroscopic biopsy grade frequently influences treatment decisions. The aim of this study was to compare the correlation of ureteroscopically derived UTUC biopsies and subsequent radical nephroureterectomy (NU) grades using the 1973 and 2004 WHO classification systems for grading urothelial carcinoma. Ureteroscopically derived grade was also correlated to NU stage using both classification systems. METHODS A retrospective review was performed of 170 consecutive patients who underwent NU for suspected UTUC at our institution over a 14-year period. After applying exclusion criteria, we had 97 patients with both ureteroscopic and NU grade available. Ureteroscopic biopsy specimens were then compared to the final NU specimen to determine grade and stage concordance using both the 1973 and 2004 WHO classification systems. The 1973 Grade 1 lesions and grade 3 lesions were considered low grade and high grade, respectively, according to the 2004 system. A cytopathologist applied the 2004 classification to all 1973 grade 2 lesions. RESULTS When the 2004 system was applied to 1973 grade 2 ureteroscopic biopsies, 16/34 (47%) were noted to be high grade. When considering ureteroscopic biopsy grades 1, 1-2, and 2 in the 1973 system, 58% of these cases correlated to ≤grade 2 on NU specimen while 60% of low grade cases using the 2004 system were found to be low grade on NU. Both grading systems showed significant association between NU grade and pathological stage. The 2004 system found better correlation with low-grade disease on ureteroscopic biopsy to superficial stage (<pT2) on NU (62%) compared to the 1973 system (53%) (κ coefficient 0.32 vs. 0.18, respectively). CONCLUSIONS Similar to urothelial carcinoma of the bladder, our findings suggest that grade heterogeneity exists in UTUC. When the 2004 WHO classification system was utilized, ureteroscopic biopsy grade could predict the final NU grade and pathological stage more accurately than the 1973 WHO classification system. Caution must be exercised when interpreting the results of UTUC studies exclusively using the 1973 WHO grading system, given the apparent heterogeneity of 1973 grade 2 lesion. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e324 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ryuta Tanimoto More articles by this author Scott G Hubosky More articles by this author Kelly A Healy More articles by this author Ruth Birbe More articles by this author Marluce Bibbo More articles by this author Demetrius H Bagley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...