A novel upper tract ureteroscopic biopsy technique: the “form tackle”

ABSTRACT

Introduction and Objective:

Upper tract urothelial carcinoma (UTUC) represents 5% of all urothelial malignancies (¹–³). Accurate pathologic diagnosis is key and may direct treatment decisions. Current ureteroscopic biopsy techniques include cold-cup, backloaded cold-cup and stone basket (⁴–⁶). The study objective was to compare a standard cold-cup biopsy technique to a novel cold-cup biopsy technique and evaluate histopathologic results.

Materials and Methods:

We developed a novel UTUC biopsy technique termed the “form tackle” biopsy. Ureteroscope is passed into ureter/renal collecting system. Cold-cup forceps are opened and pressed into the lesion base (to engage the urothelial wall/submucosal tissue) then closed. Ureteroscope/forceps are advanced forward 3-10mm and then extracted from the patient. We compared standard versus novel upper tract biopsy techniques in a series of patients with lesions ≥1cm. In each procedure, two standard and two novel biopsies were obtained from the same lesion. The primary study aim was diagnosis of malignancy. IRB approved: 21-006907.

Results:

Fourteen procedures performed on 12 patients between June 2020 and March 2021. Twenty-eight specimens sent (14 standard, 14 novel) (Two biopsies per specimen). Ten procedures with concordant pathology. In 4 procedures the novel biopsy technique resulted in a diagnosis of UTUC (2 high-grade, 2 low-grade) in the setting of a benign standard biopsy. Significant difference in pathologic diagnoses was detected between standard and novel upper tract biopsy techniques (p=0.008).

Conclusions:

The “form tackle” upper tract ureteroscopic biopsy technique provides higher tissue yield which may increase diagnostic accuracy. Further study on additional patients required. Early results are encouraging.

REFERENCES

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  Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester RJ, Burger M, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2017 Update. Eur Urol. 2018; 73:111-22.
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  Lama DJ, Safiullah S, Patel RM, Lee TK, Balani JP, Zhang L, et al. Multi-institutional Evaluation of Upper Urinary Tract Biopsy Using Backloaded Cup Biopsy Forceps, a Nitinol Basket, and Standard Cup Biopsy Forceps. Urology. 2018; 117:89-94.

Publication Dates

• Publication in this collection
  11 Mar 2022
• Date of issue
  Mar-Apr 2022

History

• Received
  28 June 2021
• Accepted
  14 July 2021
• Published
  10 Sept 2021