From the Research
Necrotic tissue is found in approximately 14% of upper tract urothelial carcinoma (UTUC) biopsies, and its presence is more characteristic of high-grade tumors, which often require additional sampling for diagnosis. The frequency of biopsy revealing only necrotic tissue in the renal pelvis for suspected UTUC is a significant concern, as it can lead to non-diagnostic results and necessitate repeat sampling. According to the study by 1, 14% of preoperative biopsies lacked neoplastic diagnoses, highlighting the challenges of obtaining accurate tissue samples from the upper urinary tract.
Key Findings
- Low-grade urothelial carcinomas typically do not demonstrate significant necrosis on biopsy, whereas high-grade tumors often show extensive necrotic tissue due to rapid growth outpacing blood supply.
- The presence of necrotic tissue in a biopsy should be considered non-diagnostic rather than negative, and additional sampling is usually recommended.
- Correlation with imaging findings and urine cytology can help guide management decisions until a definitive diagnosis is established.
- Urologists should be aware that sampling error is common in UTUC biopsies due to the limited tissue obtained and the technical challenges of accessing the upper urinary tract.
Diagnostic Challenges
- The study by 2 highlights the diagnostic challenges of UTUC, with sensitivities of biopsy, lower tract cytology, and UT cytology varying across tumor grades and stages.
- The combination of UT cytology and biopsy can improve diagnostic sensitivities, particularly for high-grade UTUC.
- The study by 3 emphasizes the importance of high-grade biopsy results in predicting advanced pathology of UTUC tumors at definitive surgical resection.
Clinical Implications
- The management of UTUC requires careful consideration of biopsy results, imaging findings, and urine cytology to guide treatment decisions.
- The study by 4 suggests that the route of administration for UGN-101, a chemoablation agent, can impact oncological and safety outcomes, with antegrade administration showing a lower rate of ureteral stricture occurrence.
- Urologists should prioritize careful patient selection, thorough diagnostic evaluation, and individualized treatment planning to optimize outcomes for patients with suspected UTUC.