Unveiling the challenges of UTUC biopsies and cytology: insights from a global real-world practice study

Purpose Diagnostic ureteroscopy (dURS) is optional in the assessment of patients with upper tract urothelial carcinoma (UTUC) and provides the possibility of obtaining histology.

Methods To evaluate endoscopic biopsy techniques and outcomes, we assessed data from patients from the CROES-UTUC registry.

The registry includes multicenter prospective collected data on diagnosis and management of patients suspected having UTUC.

Results We assessed 2380 patients from 101 centers.

dURS with biopsy was performed in 31.6% of patients.

The quality of samples was sufficient for diagnosis in 83.5% of cases.

There was no significant association between biopsy techniques and quality ( p  = 0.458).

High-grade biopsy accurately predicted high-grade disease in 95.7% and high-risk stage disease in 86%.

In ureteroscopic low-grade tumours, the prediction of subsequent low-grade disease was 66.9% and low-risk stage Ta-disease 35.8%.

Ureteroscopic staging correctly predicted non-invasive Ta-disease and ≥ T1 disease in 48.9% and 47.9% of patients, respectively.

Cytology outcomes did not provide additional value in predicting tumour grade.

Conclusion Biopsy results adequately predict high-grade and high-risk disease, but approximately one-third of patients are under-staged.

Two-thirds of patients with low-grade URS-biopsy have high-risk stage disease, highlighting the need for improved diagnostics to better assess patient risk and guide treatment decisions.

Clinical trial registration: The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188 ).