94 Correlation of Upper Urinary Tract Biopsy and Washings for Diagnosis of Urothelial Carcinoma

• Published in: American journal of clinical pathology Vol. 149; no. suppl_1; pp. S40 - S41
• Main Authors: Fidai, Shiraz, Antic, Tatjana
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 11.01.2018
• Subjects: Biopsy; Bladder cancer; Cellular biology; Cytology; Diagnosis; Medical diagnosis; Urinary tract; Urothelial carcinoma
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqx117.093

Abstract Objectives Evaluate diagnostic performances of biopsies and washings separately, their concordance with one another, and correlate them with presence of urothelial carcinoma (UC) on the final resection specimen. Methods Biopsies/washings from 2005 to 2015 were compared with nephroureterectomy (total 126 patients). Cytology diagnoses of UC or suspicious for UC were considered positive. Results Of the 126 patients with resection, 72 had prior diagnostic material. Of those 72, 26% (n = 33) had combined biopsy and washings, 21% (n = 26) had biopsies only, and 10% (n = 13) had washings only. In the combined cases, 45% (n = 15) of the diagnoses were concordant (positive biopsy and cytology) and had UC in the resection specimen. Although considered concordant, one patient had negative results on both, but had UC on resection. Of the 17 discordant cases, 65% of the biopsies (n = 11) had UC when the washings were either negative (n = 8) or non-diagnostic (n = 3). In contrast, 24% washings (n = 4) were positive when the biopsies were negative. In the remaining cases (11%, n = 2), neither was better than the other regarding diagnosis of UC. One biopsy was negative and washing was non-diagnostic, and in the second case, biopsy was negative and the washing was atypical and suspicious for neoplasm. Further analysis of 11 positive biopsies included five low-grade papillary UC, four high-grade papillary UC, one urothelial carcinoma in situ, and one high-grade urothelial carcinoma suspicious for invasion. In biopsy-only cases, 88% (n = 23) had UC, and 12% (n = 3) were negative for UC, all of whom had UC on the final resection. In washing-only cases, 92% (n = 12) were called positive, and 8% (n = 1) called negative, all of whom had UC on the final resection. Conclusion Overall, both upper tract biopsies and washings (83% for biopsies and 59% for washings) are appropriate in diagnosing UC. However, biopsies are more suitable for diagnosing low-grade papillary UC when compared to cytology.