Correlation of ureteroscopic appearance with histologic grade of upper tract transitional cell carcinoma

Objectives To correlate urologists' impressions of the tumor grade of upper tract tumors at ureteroscopy with the histologic findings after biopsy or resection. Methods A retrospective review of all patients who underwent diagnostic or therapeutic ureteroscopy for upper tract transitional cell carcinoma (TCC) between 1992 and 2002 was performed. Only patients who had proven TCC with a descriptive narration of the urologists' impressions of tumor grade and a representative pathologic specimen were included. The urologist's impression of tumor grade was reported as low or high grade according to the operative report and was correlated with the histologic grade. A total of 40 tumors met inclusion criteria. Results Ureteroscopy classified 28 tumors as low grade, 10 as high grade, and 2 as benign. The histologic findings of the 28 tumors believed to be low grade on ureteroscopy showed that 20 (71%) were grade 1-2, and of the 10 tumors believed to be high grade, 8 (80%) were actually grade 3-4. The overall accuracy of ureteroscopy in predicting the tumor grade of upper tract TCC was 70%. The benign-appearing lesions proved to be malignant. Conclusions The urologists' impressions of tumor grade on ureteroscopy were relatively good. However, visual assessment alone was inaccurate in 30% of the cases in our series. Therefore, we believe that biopsies remain essential for accurate grading of upper tract TCC. Therapeutic decisions should not be based solely on visual ureteroscopic assessment of tumor appearance.