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World Journal of Urology
Published in: World Journal of Urology 11/2019

Open Access 01-11-2019 | Ureterorenoscopy | Topic Paper

Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper tract urothelial carcinoma

Authors: Grzegorz Fojecki, Anders Magnusson, Olivier Traxer, Joyce Baard, Palle Jörn Sloth Osther, Georg Jaremko, Christian Seitz, Thomas Knoll, Guido Giusti, Marianne Brehmer

Published in: World Journal of Urology | Issue 11/2019

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Abstract

Purpose

To summarize knowledge on upper urinary tract carcinoma (UTUC) regarding diagnostic procedures, risk factors and prognostic markers.

Methods

A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC in Stockholm, September 2018.

Results

Tumor stage and grade are the most important prognostic factors. CT urography (CTU) including corticomedullary phase is the preferred imaging modality. A clear tumor on CTU in combination with high-grade UTUC in urine cytology identifies high-risk UTUC, and in some cases indirect staging can be obtained. Bladder urine cytology has limited sensitivity, and in most cases ureterorenoscopy (URS) with in situ samples for cytology and histopathology are mandatory for exact diagnosis. Image-enhancing techniques, Image S1 and narrow-band imaging, may improve tumor detection at URS. Direct confocal laser endomicroscopy may help to define grade during URS. There is strong correlation between stage and grade, accordingly correct grading is crucial. The correlation is more pronounced using the 1999 WHO than the 2004 classification: however, the 1999 system risks greater interobserver variability. Using both systems is advisable. A number of tissue-based molecular markers have been studied. None has proven ready for use in clinical practice.

Conclusions

Correct grading and staging of UTUC are mandatory for adequate treatment decisions. Optimal diagnostic workup should include CTU with corticomedullary phase, URS with in situ cytology and biopsies. Both WHO classification systems (1999 and 2004) should be used to decrease risk of undergrading or overtreatment.
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Metadata
Title
Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper tract urothelial carcinoma
Authors
Grzegorz Fojecki
Anders Magnusson
Olivier Traxer
Joyce Baard
Palle Jörn Sloth Osther
Georg Jaremko
Christian Seitz
Thomas Knoll
Guido Giusti
Marianne Brehmer
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 11/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-019-02732-8

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