abstract: Diagnostic dilemmas in patients with upper tract urothelial carcinoma : Nature Reviews Urology : Nature Research
Nature Reviews Urology
doi:10.1038/nrurol.2016.252
Upper tract urothelial carcinoma (UTUC) is a rare condition
and recommendations based on a high level of evidence for diagnosis,
treatment and follow-up monitoring are lacking. Current decision-making
is often based on evidence from trials investigating urothelial
carcinoma of the lower tract. Radical nephroureterectomy has been the
standard of care for UTUC but kidney-sparing treatment using endoscopic
approaches has been established for a select patient group with
low-grade and low-stage disease. Optimal treatment choice requires
correct tumour characterization. According to available recommendations,
diagnostic work-up of UTUC includes evaluation by CT urography or MRI
urography, cystoscopy and urine cytology.Ureterorenoscopy and lesion
biopsy are grade C recommendations in patients with suspected UTUC. When
kidney-sparing treatment is planned, ureterorenoscopy and biopsy should
be considered and are the procedures of choice in most cases. These
diagnostics have limitations and their accuracy varies in defining
tumour characteristics and predicting grade and stage. Urinary tests
have higher sensitivity than cytology for detection of lower tract
urothelial carcinoma but evidence of their benefit in UTUCs is lacking.
New optical and image enhancement techniques are being developed to
facilitate real-time diagnostics with increased accuracy. A new
diagnostic algorithm for patients with suspected UTUC that integrates
the diagnosis, treatment and clinical risk stratification is required.
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