Clinical utility and concordance of upper urinary tract cytology and biopsy in predicting Clinicopathologic features of upper urinary tract urothelial carcinoma.

5% of urothelial carcinoma occurs in the upper urinary tract (UUT), a challenging location to biopsy. We aim to evaluate concordance between biopsy, cytology, and resection specimens in a large upper tract urothelial carcinoma (UTUC) cohort. 117 UTUC resections with UUT biopsy and/or cytology specimens from 2000-2016 were retrieved; pathologic material was re-reviewed, evaluated for concordance, and correlated with clinical information. 14% pre-operative biopsies, including 8 from renal pelvis and 6 from ureter, lacked neoplastic diagnoses. 77% diagnostic biopsies included subepithelial tissue; 11% demonstrated reclassification of grade and 30% demonstrated reclassification of invasion status. 26% of renal pelvis UTUC and 36% ureter UTUC were invasive only on resection. Of 18 UTUC reclassified from noninvasive high-grade papillary urothelial carcinoma (HGPUC) to invasive HGPUC, 39% had prior radical cystectomy (versus 8% invasive UTUC and 11% noninvasive UTUC with concordant biopsies). Most high-grade UTUC (88%) and some low-grade UTUC (58%) resections had abnormal cytology results. Biopsy-resection pairs with concordant invasion status and pairs with discordant invasion status showed similar rates of recurrence (38% versus 38%) and metastasis (25% versus 27%). 14% of UUT biopsies lacked diagnostic neoplastic material. Grade concordance between biopsy and resection was high (89%), but 30% of cases showed invasion only on resection. Subepithelial tissue was less commonly present in ureter biopsies, particularly from mid or proximal ureter. UTUC in patients with prior cystectomy were more likely to show invasion on resection but not biopsy.

Human pathology. 2018 Dec 08 [Epub ahead of print]

Caroline Talsma Simon, Stephanie L Skala, Alon Z Weizer, Sapan N Ambani, Arul M Chinnaiyan, Ganesh Palapattu, Khaled Hafez, Martin J Magers, Samuel D Kaffenberger, Daniel E Spratt, Jeffrey S Montgomery, Todd M Morgan, Aaron M Udager, Madelyn Lew, Rohit Mehra

Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA., Department of Urology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA., Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Urology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA; Michigan Center for Translational Pathology, 5309 CCC 5940, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Room 2017, Palmer Commons, 100 Washtenaw Ave, Ann Arbor, MI, 48109, USA; Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, 1500, E Medical Center Drive, MI; Comprehensive Cancer Center, University of Michigan Medical School, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA., Department of Pathology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA., Department of Radiation Oncology, University of Michigan, UH B2C490, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA., Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, 5309 CCC 5940, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA; Comprehensive Cancer Center, University of Michigan Medical School, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA. Electronic address: .