NBI-assisted digital flexible ureteroscopy in transitional renal cell carcinoma - an evidence-based assessment through the looking glass of the pathological analysis

Vol. 59 No. 4, 2018

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Valentin Florin Iordache, Petrisor Aurelian Geavlete, Dragos Adrian Georgescu, Cosmin Victor Ene, Maria Alexandra Paunescu, Andrei Niculae, Ileana Peride, Tiberiu Paul Neagu, Catalin Andrei Bulai, Georgiana Xenia Balan, Bogdan Florin Geavlete, Ioan Lascar

Introduction: Digital flexible ureteroscopy (FURS) increasingly became a routine diagnostic procedure in upper urinary tract transitional cell carcinoma (UUT-TCC). Identifying elements that may suggest the malignant nature of a lesion and obtaining biopsy specimens sufficient for a reliable pathological analysis remain difficult challenges. Narrow-band imaging (NBI) technology appears to provide a more accurate observation of the upper tract urothelium. Patients, Materials and Methods: During this prospective analysis, white light (WL) and NBI-assisted digital FURS were performed in 87 consecutive patients admitted for primary suspicion of UUT-TCC. The endoscopic technique comprised digital WL FURS, followed by the NBI assessment of the renal collecting system mucosa. All suspicious areas of the pyelocaliceal urothelium were biopsied using the grasping forceps, separately for WL and NBI findings. Results: A total of 113 UUT-TCC tumors (104 pTa and nine carcinoma in situ - CIS) were confirmed by pathology in 62 patients. The patients detection rate was significantly improved in NBI mode when compared to standard FURS (98.4% versus 91.9%, respectively), due to cases either exclusively diagnosed with UUT-TCC (8.1%) or presenting additional urothelial tumors (12.9%). Overall, 13 pTa and two CIS lesions were solely observed in NBI, which was on the other hand characterized by a significantly increased proportion of unnecessary biopsies (NBI versus WL rate of false-positive results - 17.5% versus 10.1%, respectively). Conclusions: As additional tool for the standard WL evaluation of the pyelocaliceal system urothelium, NBI-guided biopsies were emphasized as providing a significant diagnostic improvement during digital FURS.

Corresponding author: Tiberiu Paul Neagu, Assistant Professor, MD; e-mail: dr.neagupaul@gmail.com

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