Cytologic diagnosis of upper urinary tract neoplasms by ureteroscopic sampling

During a three-year period, 160 cytologic specimens from the upper urinary tract (UUT) were collected from 62 patients. The specimens were obtained during ureteroscopy using various sampling techniques, including washing, brushing, aspiration and minute biopsies. The patients ranged from 17 to 84 years of age and consisted of 32 men and 30 women. For each patient one diagnosis that indicated the highest degree of abnormality was selected. These consisted of 23 "malignant," 9 "suspicious for malignant," 19 "atypical," 8 "negative for malignancy" and 3 "unsatisfactory" diagnoses. Of 30 patients with a malignant or suspicious diagnosis for whom adequate clinical and follow-up information was available, 18 had histologic confirmation of malignancy, and the other 12 had clinical and endoscopic evidence of neoplasms. Of 15 patients with an atypical diagnosis and adequate follow-up, 2 proved to have low grade transitional cell carcinoma, 1 had a fibroepithelial polyp, and 12 had clinical, endoscopic and follow-up evidence of nonneoplastic conditions. None of the 11 cases with negative or unsatisfactory diagnoses was found to have a malignant neoplasm. Because of the difficulty in obtaining adequate biopsies from UUT lesions, cytologic examination is the most practical method of diagnosis. This study indicated that highly accurate results are achieved, with close correlation between endoscopic and cytologic findings.