Carcinoma In Situ Is Significantly Underdetected by Prenephroureterectomy Ureteroscopy in the Management of Upper Tract Urothelial Cancers
| Autor: | Jason Alcorn, Ghulam Nabi, Ismail El-Mokadem, Ranan Dasgupta, Chandra Shekhar Biyani, Altaf Shams ud din, Angela Gillan, Stephen Lang, Bhavan Prasad Rai |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Article Subject Biopsy Urology lcsh:Medicine Nephrectomy General Biochemistry Genetics and Molecular Biology Cohort Studies Ureteroscopy medicine Carcinoma Humans Stage (cooking) Aged Demography Carcinoma Transitional Cell General Immunology and Microbiology medicine.diagnostic_test business.industry Carcinoma in situ lcsh:R Retrospective cohort study General Medicine Reference Standards medicine.disease Transitional cell carcinoma Female Histopathology Ureter Urothelium business Carcinoma in Situ Research Article |
| Zdroj: | BioMed Research International BioMed Research International, Vol 2015 (2015) |
| ISSN: | 2314-6141 2314-6133 |
| Popis: | Objective. Diagnostic reliability of prenephroureterectomy ureteroscopy (PNU) for the detection of upper tract carcinoma in situ (CIS) remains unproven in particular and underreported in general.Methods. Patients who underwent radical nephroureterectomy (RNU) in a large multicentre retrospective study for upper tract transitional cell carcinoma (UT-TCC) between January 2002 and December 2013 were identified from our hospitals databases. PNU appearances, stage, and grade of ureteroscopic biopsy were compared with final histology results of RNU to assess the diagnostic reliability of PNU for carcinoma in situ (CIS).Results. Three hundred patients underwent RNU for UT-TCC. 106 (106/300; 35.3%) of the cohort had PNU using white light with biopsies taken in most (92/106; 86.7%). Postnephroureterectomy histology of the cohort showed CIS in 65 (65/300; 21.6%) patients. Thirty nine of patients with CIS (39/65; 60%) had prenephroureterectomy ureteroscopy biopsies. Out of ten patients with CIS on ureteroscopic biopsies, six did not show CIS on final histopathology (6/10; 60%). Moreover, grading and staging on PNU biopsies of obvious tumours showed a significant nonconcordance with final histopathology of RNU specimen(P=0.02). Overall survival was also shorter in patients with CIS compared with those without; this showed strong statistical significance(P=0.004).Conclusions. There is a high incidence of CIS in upper tract with significant underdetection and discordance rate between the histopathology of biopsy samples obtained by white light PNU and resected specimen of radical nephroureterectomy. The presence of concomitant CIS and high stage disease in the upper tract TCC carried a poor prognosis following radical nephroureterectomy. |
| Databáze: | OpenAIRE |
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