OBJECTIVES: Pathologic examination of ureteral margins during radical cystectomy (RC) occasionally reveals lesions present in proximal but not in distal ureteral sections ("skip lesions").
We assessed the incidence and clinical significance of these lesions.
METHODS: We identified 660 patients who underwent a RC and had at least 2 permanent margins for a given ureter. Overall, 1173 ureters were analyzed and classified as the followings: "normal" (no tumor, reactive atypia, mild or moderate dysplasia) or "abnormal" (severe dysplasia, carcinoma in situ (CIS), or tumor). Transitions from "normal" distal pathology to "abnormal" on proximal section(s) determined frequency of skip lesions. Fisher's exact test and log-rank test were used to study correlations.
RESULTS: Ureteral skip lesions were found in 4.8% patients (2.9% ureters). Pathology of skip lesions was CIS: 55.9%, TCC: 23.5% and severe dysplasia in 20.6%. Skip lesions were associated with lymphovascular invasion (34.4% vs. 13.7%, p=0.0035) and advanced pT stage (p=0.0068). On multivariate analysis, skip lesions correlated with lower median overall survival (OS) (inestimable vs. 8.2 years, p=0.014) in patients with pT0 or pTa disease and a trend towards lower OS (2.7 years vs. 8.8 years, p=0.066) in pTis disease. Concordance between frozen distal margin and permanent proximal margin varied; sensitivity was 80% in those without and 20% in those with skip lesions.
CONCLUSIONS: The presence of a ureteral skip lesion may be associated with lower survival in patients with pT0, pTa or pTis urothelial carcinoma. Thus, while uncommon, ureteral skip lesions should be reported in pathologic findings.
Written by:
Hoang AN, Agarwal PK, Walton-Diaz A, Wood CG, Metwalli AR, Kassouf W, Brown GA, Black PC, Urbauer DL, Grossman HB, Dinney CP, Kamat AM. Are you the author?
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Reference: BJU Int. 2013 Jul 2. Epub ahead of print.
doi: 10.1111/bju.12344
PubMed Abstract
PMID: 24053608
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