Carcinoma In Situ Is Significantly Underdetected by Prenephroureterectomy Ureteroscopy in the Management of Upper Tract Urothelial CancersReportar como inadecuado

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BioMed Research International - Volume 2015 2015, Article ID 547586, 7 pages -

Research Article

Academic Section of Urology, Division of Imaging and Technology Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK

Department of Pathology, Ninewells Hospital, NHS Tayside Health Board, Dundee DD1 9SY, UK

Department of Urology, Pinderfield General Hospital and Mid Yorkshire NHS Trust, Wakefield, UK

Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK

Received 26 July 2014; Revised 5 October 2014; Accepted 14 October 2014

Academic Editor: Giovanni Lughezzani

Copyright © 2015 Angela Gillan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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 . Overall survival was also shorter in patients with CIS compared with those without; this showed strong statistical significance . 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.

Autor: Angela Gillan, Ismail El-Mokadem, Bhavan Rai, Stephen Lang, Jason Alcorn, Altaf Shams ud din, Ranan Dasgupta, Chandra Shekh



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