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Purpose <p>The use of systematic biopsies (SB) in patients with suspicion of upper tract urothelial carcinoma (UTUC) has not been explored. Our objective is to investigate the safety of SB and its impact on the management of UTUC.</p> Methods <p>We included patients who underwent diagnostic ureteroscopy (URS) ± ablation treatment and SB for UTUC at our institution (2015–2022). SB consisted of a minimum of two biopsies in renal pelvis, proximal, medium, and distal ureter. Complications were graded using Clavien-Dindo classification. The impact of SB on oncological outcomes was assessed through Kaplan-Meier curves and Cox regression analysis. Logistic regressions were used to assess predictors of positive SB.</p> Results <p>Overall, 50/101 (50%) patients had positive SB. Overall and major complications were 19 (19%) and 4 (4%), respectively. SB detected UTUC in 8/16 (50%) and 18/23 (78%) patients with negative/nondiagnostic and positive target biopsy, respectively. In 8/25 (32%) distal ureteral tumors, SB detected CIS in other upper tract portions. Patients with positive SB were more frequently treated with radical nephroureterectomy (RNU) (2-yr RNU-FS rates 87.7% vs. 53.5%, <i>p</i> &lt; 0.001). SB was an independent predictor of RNU-FS [HR 3.38 (95%CI 1.46–7.80); <i>p</i> = 0.004]. History of CIS [OR 1.26 (95%CI 1.06–1.91), <i>p</i> = 0.04] and tumors ≥ 2&#xa0;cm [OR 1.32 (95%CI 1.09–1.78), <i>p</i> = 0.04] were independent predictors of SB positivity. Limitations include the single-center, retrospective design of the study.</p> Conclusions <p>The integration of SB into the diagnostic workup of UTUC is safe and feasible. It may drive the treatment choice in high-risk patients.</p>

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Systematic biopsies of the upper urinary tract: a tool to improve the diagnostic accuracy of ureteroscopy and characterization of upper tract urothelial cancer

  • 期刊论文

  • 发表日期：

    2025年10月16日

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  • Andrea Gallioli,
  • Giuseppe Basile,
  • Donato Cannoletta,
  • Angelo Territo,
  • Luca Afferi,
  • Paula Izquierdo,
  • Alba Farré,
  • Lucía Diéguez,
  • Pietro Diana,
  • Francesco Di Bello,
  • Stefano Mancon,
  • Pavel Gavrilov,
  • Josep Maria Gaya,
  • Ferran Algaba,
  • Joan Palou,
  • Alberto Breda

摘要

Purpose

The use of systematic biopsies (SB) in patients with suspicion of upper tract urothelial carcinoma (UTUC) has not been explored. Our objective is to investigate the safety of SB and its impact on the management of UTUC.

Methods

We included patients who underwent diagnostic ureteroscopy (URS) ± ablation treatment and SB for UTUC at our institution (2015–2022). SB consisted of a minimum of two biopsies in renal pelvis, proximal, medium, and distal ureter. Complications were graded using Clavien-Dindo classification. The impact of SB on oncological outcomes was assessed through Kaplan-Meier curves and Cox regression analysis. Logistic regressions were used to assess predictors of positive SB.

Results

Overall, 50/101 (50%) patients had positive SB. Overall and major complications were 19 (19%) and 4 (4%), respectively. SB detected UTUC in 8/16 (50%) and 18/23 (78%) patients with negative/nondiagnostic and positive target biopsy, respectively. In 8/25 (32%) distal ureteral tumors, SB detected CIS in other upper tract portions. Patients with positive SB were more frequently treated with radical nephroureterectomy (RNU) (2-yr RNU-FS rates 87.7% vs. 53.5%, p < 0.001). SB was an independent predictor of RNU-FS [HR 3.38 (95%CI 1.46–7.80); p = 0.004]. History of CIS [OR 1.26 (95%CI 1.06–1.91), p = 0.04] and tumors ≥ 2 cm [OR 1.32 (95%CI 1.09–1.78), p = 0.04] were independent predictors of SB positivity. Limitations include the single-center, retrospective design of the study.

Conclusions

The integration of SB into the diagnostic workup of UTUC is safe and feasible. It may drive the treatment choice in high-risk patients.