JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 15

Abstracts
Panwar P1, Thursby H1, Kalyanasundaram K1, Golash
A1, Fernando H1
1University Hospitals of North Midlands, Stoke on Trent, United
Kingdom

Introduction: Diagnosis of upper tract urothelial cancer
(UTUC) is currently based on combination of imaging,
cytology and/ or ureterorenoscopy (URS) with or without
biopsy. With the ongoing debate about routine use of ureteroscopic biopsy, cytology and radiology assume even
more importance. We analyzed whether a combination of
cytology and imaging can replace the routine use of URS
in UTUC.
Methods: Retrospective analysis of 95 patients who
underwent laparoscopic radical nephroureterectomy
(LRNU) from January 2012 to June 2017 was done. 83
patients were finally included for this study. Modified Paris
system for cytopathology reporting was used, with C1
being normal cytology and C5 being frankly malignant cells.
Results: 88%, 60% and 52% of C4/5, C3 and C1/2 cytology patients had high grade disease in the final histology
respectively. Four patients had C4/5 cytology and equivocal radiological diagnosis had low grade UTUC. There was
a strong correlation between C4/C5 cytology and highgrade disease on final histopathology (r=0.96).In the C3
group, 44%of patients had obvious radiological evidence of
tumour, whereas 56% of patients underwent URS, which
confirmed malignancy. In the C1/C2 group, 56% of patients
had obvious radiological disease and rest of the patients
(44%) underwent URS and biopsy.
Conclusions: This study shows that preoperative URS is
not 'routinely' required in patients with C4/C5 cytology.
However, in cases with equivocal imaging and C1/C2/C3
cytology, URS is necessary to ascertain the diagnosis and
also grade the tumour, as in this group, finding of low grade
disease offers the possibility of organ preservation approach.
P1-3 The utility of pre-operative CT
urography in the diagnosis of patients with
suspected upper tract urothelial cancer
Ellis R1, Scriven S1, Lloyd J2, Ratan H1
1Department of Urology, Nottingham City Hospital, United Kingdom,
2Department of Radiology, Nottingham City Hospital, Nottingham,
United Kingdom

Introduction: There is an increasing prevalence of upper
tract urothelial carcinomas (UTUC), which account for
5-10% of urothelial tumours. The gold standard investigation of suspected UTUC includes urographic phase contrast CT (CTU) followed by ureteroscopic visualization and
biopsy. CT has a documented sensitivity of 64-100% and
specificity of 93-99% in diagnosing UTUC. This study aimed
to establish whether the degree of radiological suspicion of
UTUC on pre-operative CTU accurately predicted the
diagnosis of UTUC on subsequent ureteroscopy and biopsy

15
and therefore whether ureteroscopy could potentially be
avoided in some cases.
Methods: Patients undergoing diagnostic ureteroscopy
for suspected UTUC between 18/05/16 - 18/05/17 in our
institution were identified (n=64). The pre-operative
degree of suspicion as stated in the radiology report was
categorized and correlated with diagnosis of UTUC.
Results: 31 patients had a confirmed diagnosis of
UTUC. 22 of these had a positive tissue biopsy, with 9
others having positive cytology from ureteric washings.
Compared to the degree of pre-operative radiological
suspicion, the UTUC diagnoses were distributed as follows: "Sure" only 12 out of 17 were diagnosed with
UTUC, "likely" 2/6, "suspicious" 10/17, "possible" 6/16
and "unlikely" 1/8.
Conclusions: This study demonstrated poor correlation
between pre-operative degree of radiological suspicion of
UTUC and findings at diagnostic ureteroscopy. These
results therefore support our current practice of performing diagnostic ureteroscopy in all patients suspected
of having UTUC prior to a nephroureterectomy. This
study has prompted other centres within the region to
discuss their policies on the investigation of UTUC prior
to definitive surgical intervention.
P1-4 Is it safe to proceed directly to
nephro-ureterectomy without diagnostic
ureteroscopy in patients with suspected
upper tract urothelial cancer on CT urogram?
Trail M1, Waheed-Rahman S1, Broadhurst W1, Phipps
S1, Thomas B1, Cutress M1, McNeill A1, O'Donnell M1,
Leung S1, Laird A1
1NHS Lothian University Hospitals, Edinburgh, United Kingdom

Introduction: Following CT urography (CTU) suggestive
of upper-tract urothelial carcinoma (UTTCC), patients
will often undergo diagnostic flexible uretero-renoscopy
(FURS) before proceeding to nephro-ureterectomy (NU).
This can cause significant delay within the diagnostic pathway. We aimed to identify clinico-radiological markers of
UTTCC to predict high-risk patients who can safely proceed to NU without the delay of FURS.
Methods: All patients undergoing FURS +biopsy or NU
for suspected UTTCC between 2011 and 2017 were
identified in a prospectively collected pathology database. Clinical and radiological data were collected retrospectively. Logistic regression analysis was performed in
SPSS.
Results: 207 patients with suspected UTTCC were
managed during the study period and 179(86.5%) underwent FURS. 185 patients had confirmed UTTCC, while
22 patients had benign pathology. The overall positive
predictive value of CTU for the diagnosis of UTTCC was
89.9%.

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