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Introduction: We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic biopsy and final pathology.
Materials & Methods: Preoperative URS biopsy data was available in 238 patients at 5 academic medical centers. URS biopsies were performed using either a brush biopsy kit or a mechanical biopsy device. The association between URS biopsy and final pathologic data was determined.
Results: 154 men and 84 women, with a median age of 70 years were included. On URS biopsy, 88(37%) patients had a positive brush, 140(59%) were staged as non-MI, and 10(4%) had MI disease. In addition, 140(59%) biopsies were low grade while 98(41%) were high grade. RNU pathology, demonstrated non-MI tumors in 140(59%) patients, MI UTUC in 98(41%), and high-grade disease in 150(63%), positive LN in 18(8%). On univariate analysis, high URS biopsy grade was associated with high RNU grade (p<0.001), MI UTUC (p<0.001), and LN positive UTUC (p=0.02) on RNU pathology. Conversely, URS biopsy stage was only associated with final UTUC disease grade (p=0.005), but not stage (p=0.16) or LN positivity (p=0.24). In a multivariate model that controlled for gender, age, and tumor location, URS grade (but not stage) was associated with high RNU grade (p<0.0001) and MI UTUC (p<0.0001).
Conclusions: Results from a contemporary large multi-institutional cohort of patients further supports that URS biopsy grade, but not stage, is associated with final pathology. Such information may play a valuable role for risk stratification regarding ablative versus extirpative therapies for UTUC.