Ureteroscopic cytologic diagnosis of upper tract lesions

The definitive diagnosis of upper urinary tract lesions often relies on providing adequate tissue samples for cytopathologic review. Uretreopyeloscopy allows direct examination of these lesions and enables tissue sampling under visual control. A retrospective analysis of 11 patients with 13 abnormal upper tracts was performed, comparing sampling techniques performed under endoscopic vision (brush biopsy, fine-needle aspiration [FNA], and forceps biopsy) with standard retrograde catheter lavage. Forceps biopsy was the most accurate of the direct vision sampling methods (100%), although it provided adequate tissue only 56% of the time. Direct vision brush biopsy and FNA were better than forceps biopsy at providing adequate tissue but were less accurate, at 83% and 89%, respectively. Surprisingly, retrograde catheter lavage was superior to direct vision sampling methods. These results may be attributable to patient selection bias in that five of seven upper tracts found to have malignancy had multifocal disease. One patient developed a distal ureteral stricture from instrumentation that was managed successfully with an endoureterotomy.