Effectiveness of different diagnostic tools for upper urinary tract urothelial carcinoma

ObjectiveThe results of urinalysis, radiographic studies, urinary cytology examinations, and ureterorenoscopy (URS) biopsies, as well as the results of histopathology can be used to establish a diagnosis of upper urinary tract urothelial carcinoma (UTUC).Materials and MethodsWe enrolled 99 patients who underwent radical nephroureterectomy (RNU) during the period 2003–2007. A total of 65 random urine and 83 URS washing cytology examinations, 48 intravenous urography (IVU), 59 retrograde pyelography (RP), and 81 URS biopsy results were available prior to RNU and were compared with the pathological grades and stages of these surgical specimens.ResultsNinety-three UTUCs were found among the 99 RNU specimens. Initial presentations and urinalysis results could not predict tumor stages. The patient with preoperative pyuria was significantly associated with high-grade UTUC (75.0% vs 52.6%, p = 0.031). Random urine and URS washing cytology results could not predict tumor grades or stages. The sensitivity of 3-day random urine cytology was significantly better than 2-day and 1-day examinations (p = 0.002 and p = 0.019, respectively). The abnormal findings in IVU and RP accounted for 89.4% and 100%, respectively. Non-enhancement of images was significantly associated with high tumor grading (p = 0.01). URS biopsy (n = 72) was positive for malignancy in 52 patients (69.3%). Biopsy grade had a significant correlation with surgical tumor grade (κ = 0.649) and high-grade biopsy results were significantly associated with invasive tumor stage (pT2–T4) (p = 0.004).ConclusionCombining random urine cytology for 3 nonconsecutive days, upper urinary tract images, and URS biopsies provided an accurate diagnosis of UTUC. This study found that preoperative pyuria in urinalysis, non-enhancement in IVP or RP, and high-grade tumor in URS biopsy could predict high-grade tumor in RNU specimens.