Diagnostic Role Of Urine Cytology And Ureteroscopic Biopsies In Detection Of High Grade Upper Tract Urothelial Carcinoma

Introduction: To explore the efficacy of urine cytology, ureteroscopic biopsy, and a combination of both in detecting HG UTUC. Methods: We searched our institutional pathology database for cases (2008-2018) with urine cytology and subsequent histologic follow-up based on ureteroscopic biopsy and extirpative resection performed within 6 months of the urine cytology. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for the specific diagnostic categories. Results: A cohort of 226 cases with both urine cytology and histologic follow-up based on ureteroscopic biopsies and/or surgical resection were included in the study. 144/226 cases (64%) had both urine cytology and extirpative resection, among which 57 (25%) cases also have ureteroscopic biopsy preoperatively. The sensitivities for urine cytology or ureteroscopic biopsy alone for a surgically confirmed HG UTUC were 64.7% and 59.2% respectively. Among 49 cases diagnosed as HG-UTUC by extirpative resection, 42 cases were diagnosed as HG-UTUC by either urine or biopsy diagnosis. The sensitivity of combining urine cytology and ureteroscopic biopsy was 85.7%, which was significantly higher than either method alone (P < 0.05). Conclusion: Our findings show urine cytology and ureteroscopic biopsy have comparable sensitivity in diagnosing HG UTUC. However, by combining urine cytology with ureteroscopic biopsy, there is a significant increase in the sensitivity for detecting HG UTUC and should therefore be incorporated into routine clinical practice.