AUA 2019: Percutaneous Biopsy for Upper Tract Urothelial Carcinoma - Safety and Diagnostic Accuracy

Chicago, IL ( During the Moderated Poster Session 50 on Bladder Cancer: Upper Tract Transitional Cell Carcinoma I at the Annual AUA 2019 meeting in Chicago, IL, Dr. Joseph presented his moderated poster on- Percutaneous Biopsy for Upper Tract Urothelial Carcinoma - Safety and Diagnostic Accuracy. Standard of care for obtaining a histologic diagnosis of upper tract urothelial carcinoma (UTUC) includes ureteropyeloscopy with endoscopic biopsy; however, it is not always feasible, and its diagnostic accuracy is questionable. Dr. Joseph reported their experience with percutaneous image-guided core-needle biopsy (CNB) for UTUC to better understand safety and diagnostic accuracy.

Dr. Joseph and colleagues retrospectively reviewed 444 patients undergoing radical nephroureterectomy (RNU) for UTUC at Mayo Clinic between 2009 and 2017. Forty-two patients undergoing CNB before RNU were identified, and imaging and pathology were reviewed. Grade 3 or higher complications according to the Common Terminology Criteria for Adverse Events were also identified.

Dr. Joseph then summarized the results of this study. Median age at biopsy was 72.8 years. All lesions were intrarenal. Median tumor size was 3.2 cm. CT-guidance was utilized in 52.4% (n=22), ultrasound-guidance in 47.5% (n=20). Relative to RNU pathology, rate of histologic diagnosis by CNB was 95.2% (n=40). When CNB provided histologic grade (n=29, 69%), rate of concordance with surgical pathology was 86.2% (n=25). Minor and major complication rates were 14.3% (n=6) and 2.4% (n=1) respectively. At a median biopsy-to-interval imaging time of 26.2 months (1.2-76.5), no cases of CNB tract seeding were identified.

Dr. Joseph concluded that patients undergoing RNU for UTUC, CNB was a safe and effective diagnostic tool. This is the largest reported experience with CNB for diagnosis of UTUC. Additional studies are underway to compare the diagnostic accuracy of CNB to that of endoscopic biopsy.

Presented by: Jason Joseph, MD, Mayo Clinic, Rochester, Minnesota

Written by: Abhishek Srivastava, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Fox Chase Cancer Center, Philadelphia, PA, Twitter: @shekabhishek at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois

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