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Upper Tract Urothelial Carcinoma: Ureteroscopic Biopsy and Specimen Preparation

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Ureteroscopy

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Upper tract urothelial carcinoma (UTUC) is a rare malignancy. Nevertheless, it is a potentially lethal disease, especially when diagnosed in advanced stages. Ureteroscopy with biopsy provides the most accurate diagnosis and is an essential step in the evaluation of upper urinary tract tumors. Alternative modalities including urine studies and contrast imaging have proven less reliable. Systematic “no touch” ureteroscopic techniques should be utilized to survey the involved upper tract system. Tumor biopsy may be most efficiently performed with a flat wire basket or cup forceps. All specimens should be delivered fresh in normal saline to the Cytopathology laboratory as soon as possible for optimal tissue preservation. Samples are then prepared using the Cytospin technique, and a cell block is also prepared if any macroscopically visible tissue is present. Taken together, these ureteroscopic and cytopathology techniques can help obtain an accurate diagnosis and guide treatment decisions. Endoscopic treatment of UTUC with the combination of Holmium:YAG and Neodymium:YAG lasers is a promising alternative to radical nephroureterectomy in selected cases.

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Abbreviations

UTUC:

Upper tract urothelial carcinoma

CSS:

Cancer specific survival

RNU:

Radical nephroureterectomy

CKD:

Chronic kidney disease

MDCTU:

Multidetector computed tomographic urography

OS:

Overall survival

BTA:

Bladder tumor antigen

FDP:

Fibrin/fibrinogen degradation product

FISH:

Fluorescence in situ hybridization

RPG:

Retrograde ureteropyelogram

FU:

Flexible ureteroscope

F:

French

Ho:

Holmium

Nd:

Neodymium

YAG:

Yttrium aluminum garnet

WL:

White light

CROES:

Clinical research office of the endourological society

NBI:

Narrow band imaging

TUR:

Transurethral resection

PHH3:

Phospho-histone

H&E:

Hematoxylin and eosin

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Author information

Authors and Affiliations

  1. Department of Urology and Radiology, Thomas Jefferson University, 1025 Walnut Street, Suite 1112 College Building, Philadelphia, PA, 19107, USA

    Kelly A. Healy M.D., Nir Kleinmann M.D. & Demetrius H. Bagley M.D., FACS

  2. Cytopathology Division, Pathology Department, Thomas Jefferson University, Philadelphia, PA, USA

    Marluce Bibbo M.D., Sc.D.

Authors
  1. Kelly A. Healy M.D.
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  2. Nir Kleinmann M.D.
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  3. Marluce Bibbo M.D., Sc.D.
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  4. Demetrius H. Bagley M.D., FACS
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Corresponding author

Correspondence to Demetrius H. Bagley M.D., FACS .

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Editors and Affiliations

  1. Glickman Urological & Kidney Institute, Department of Urology, The Cleveland Clinic, 2842 Fontenay Road, Cleveland, 44120, Ohio, USA

    Manoj Monga

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Healy, K.A., Kleinmann, N., Bibbo, M., Bagley, D.H. (2013). Upper Tract Urothelial Carcinoma: Ureteroscopic Biopsy and Specimen Preparation. In: Monga, M. (eds) Ureteroscopy. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-206-3_26

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  • DOI: https://doi.org/10.1007/978-1-62703-206-3_26

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