Patients with high-grade upper tract urothelial carcinoma (UTUC) have no worse survival when their initial biopsy results are discordant rather than concordant with surgical pathology, according to a poster presentation at the 20th annual meeting of the Society of Urologic Oncology in Washington DC.

Of 191 UTUC patients with high-grade UTUC on surgical pathology, 58 (30.1%) had discordant pathology and 133 had concordant pathology between diagnostic ureteroscopy and radical nephroureterectomy (RNU). Surgery occurred a mean 6 days later for patients with discordant vs concordant pathology.

Overall survival did not differ significantly between groups, Phillip Pierorazio, MD, of the James Buchanan Brady Urological Institute in Baltimore and colleagues reported. Rates of locally-advanced disease of pT2 or higher were not significantly different between patients with discordant versus concordant pathologies (48.3% vs 55.6%, respectively), even after controlling for neoadjuvant chemotherapy use.

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The investigators performed several sensitivity analyses. Using preoperative urine cytology grade rather than biopsy grade, they found no significant differences in overall survival or locally-advanced disease between groups. Likewise, analyses combining biopsy and urine cytology grades (both high-grade vs both low-grade/atypical/non-diagnostic vs 1 high-grade and 1 low-grade/atypical/non-diagnostic) also showed no significant differences.

Technical limitations in endoscopy can yield substantial rates of discordance between ureteroscopic and surgical pathology, Dr Pierorazio’s team noted. Despite these limitations, outcomes appeared similar.

“These results suggest the importance of prompt evaluation and consideration for RNU in patients for whom there is a high clinical suspicion of high-grade disease, despite low-grade or non-diagnostic biopsy or urine cytology results.”


Liao R, Cheaib J, Gupta M, et al. Implications of discordant diagnostic to final surgical pathology in high-grade upper tract urothelial carcinoma. Presented at the 20th annual meeting of the Society of Urologic Oncology held December 4 to 6, 2019, in Washington DC. Poster 35.