Table 1.
Examination and management of 31 patients with atypical urinary cytology of the upper urinary tract
| Group | Initial CT findings | N | Initial RP, cytology with/without ureterorenoscopy, biopsy |
Management and outcome |
|||||
|---|---|---|---|---|---|---|---|---|---|
| RP | upper tract urinary cytology | ureterorenoscopy | biopsy | management* | histological grading of UTUC | TNM staging of UTUC at diagnosis or follow-up | |||
| Group A | Tumor-like lesions (n = 11) | 5 | Defect | Class III | Tumor observed | Positive for UTUC | Nephroureterectomy | ①G3/high, ②G3/ high, ③G3/high, ④G3/high, ⑤G3/ high | ①TisN0M0, ②TaN0M0, ③T1N0M0, ④T3N0M0, ⑤T4N0M0 |
| 1 | Defect | Class III | Poor observation due to bleeding | Negative for UTUC | Repeated RP; positive o nephrou-reterectomy | G3/high | T3N2M0 | ||
| 4 | Defect | Class III | Not performed | Not performed | Nephroureterectomy without repeated RP | ①G3/high, ②G2/ high, ③G3/high, ④G3/high | ①TaN0M0, ②T1N0M0, ③T3N0M0, ④T3N1M0 |
||
| 1 | Unknown | Class III | Not performed | Not performed | Nephroureterectomy without repeated RP | G2/low | TaN0M0 | ||
| Group B | Wall thickening without tumor-like lesions | 1 | Defect | Class III | Tumor observed | Positive for UTUC | Nephroureterectomy | G3/high | T3N0M0 |
| (n = 8) | 1 | Negative | Class III | Tumor observed | Positive for UTUC | Nephroureterectomy | G3/high | T3N1M0 | |
| 1 | Negative | Class III | No tumor observed | Negative for UTUC | Repeated RP; negative | na | NED at 132 months | ||
| 1 | Negative | Class III | No tumor observed | Not performed | Repeated RP; negative | na | NED at 51 months | ||
| 1 1 |
Stenosis Negative |
Class III Class III | Not performed No tumor observed | Not performed Negative for UTUC |
Observation dthsascheduled RP; positive onnephroureterectomy Observation → nonscheduled RP; negative | G3/high na |
TisN2M0 NED at 23 months | ||
| 2 | Negative | Class III | Not performed | Not performed | Observation | na | NED at 42 and 131 months | ||
| Group C | Hydronephrosis without tumor-like lesions or wall thickening (n = 4) |
1 | Negative | Class III | No tumor observed | Negative for UTUC | Repeated RP; negative | na | NED at 77 months |
| 1 | Stenosis | Class III | Not performed | Not performed | Observation dthsascheduled RP with biopsy; positive | G3/high | T1N0M1 | ||
| 2 | Stenosis | Class III | Not performed | Not performed | Observation | na | NED at 16 and 80 months | ||
| Group D | Normal findings (n = 8) | 1 | Negative | Class III | Tumor observed | Positive for UTUC | Endoscopic resection | G2/low | TaN0M0 |
| 1 | Negative | Class III | Not performed | Not performed | Repeated RP; positive →enephrou-reterectomy | G3/high | TisN0M0 | ||
| 1 | Stenosis | Class III | Not performed | Not performed | Repeated RP; negative | na | NED at 15 months | ||
| 1 | Negative | Class III | Not performed | Not performed | Repeated RP; negative | na | NED at 26 months | ||
| 1 | Stenosis | Class III | Not performed | Not performed | Observation | na | NED at 53 months | ||
| 3 | Negative | Class III | Not performed | Not performed | Observation | na | NED at 17, 34, and 78 months | ||
na, not applicable; NED, no evidence of disease; UTUC, urinary tract urothelial carcinoma; CT, computed tomography.
*
Repeated RP and nonscheduled RP include reexamination of upper tract urinary cytology with/without ureterorenoscopy and biopsy. Repeated RP was performed within 6 months after initial RP. Nonscheduled RP was performed following changes in CT and/or cytology findings after observation.