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- Title
Diagnostic developments and treatment strategies in the endoscopic management of upper-tract urothelial carcinoma.
- Authors
Mihai, Stan; Geavlete, P.; Ene, C.; Geavlete, B.
- Abstract
Introduction: Upper-tract urothelial carcinoma (UTUC) accounts for 5-10% of urothelial carcinomas. The 'gold standard' surgical treatment for UTUC is still represented by radical nephroureterectomy (RNU) with bladder cuff excision. The European Association of Urology guidelines recommend offering kidney-sparing surgery (KSS) as primary treatment option to patients with low-risk disease. Sometimes, there is a lack of certainty regarding the diagnosis and tratment strategy of UTUC despite all techniques available such as cystoscopy, urinary citology, and computed tomography urography (CTU) which do now always allow correct tumor staging and grading. Diagnostic ureteroscopy (d-URS) may be of crucial importance in establishing the appropriate therapeutic approach. Evidence acquisition: A systematic review of the literature using Pubmed electronic database was performed for studies evaluating the diagnostic modalities and tratment strategies in UTUC. Overall, 74 full-text articles were assessed for eligibility. After a quantitative review of the selected literature, 24 studies were considered relevant for this review. Results: CTU has a sensitivity and specificity for UTUC of 92% and 95% respectively, but is not able to detect small or flat lessions with adequate accuracy. Urine citology for UTUC has a sensitivity of around 67-76% and is considered to offer poor prediction of muscle-invasive or high-grade disease. As no technique offers a diagnosis certainty, diagnostic ureteroscopy with enhanced technical improvements and emerging technologies can allow an increase in diagnostic accuracy by distinguishing between normal tissue and low- and high-grade tumors. Conclusions: Endoscopic treatment of even large, multifocal, low grade upper urothelial carcinoma is feasible also depending on each comfort level of expertise, does not involve significant complications and has good short-term oncologic outcomes. Proper patient selection is the main key for a better outcome when treating UUTC endoscopically. A better appreciation of the diagnostic limitations may help with choosing the weapon wisely. Maybe the most important feature of all is that the patient needs to be willing to undergo a close follow up with repetead endoscopic evaluations.
- Subjects
TRANSITIONAL cell carcinoma; ENDOSCOPIC surgery; TECHNOLOGICAL innovations; BLADDER cancer; THERAPEUTICS; TUMOR grading
- Publication
Romanian Journal of Urology, 2021, Vol 20, Issue 1, p8
- ISSN
1223-0650
- Publication type
Article