To summarise the current knowledge regarding diagnostics, prognostication and follow-up in upper tract urothelial carcinoma (UTUC).
A scoping review combined with expert opinion was applied to provide an overview of the current research field. Based on the published literature and the experts' own experience and opinions, consensus was reached through presentations and discussions at the meeting Consultation on UTUC II in Stockholm 2022.
The strongest prognostic factors in UTUC are tumour grade and stage. They are correlated, and grade is used for indirect staging. The diagnostic examinations should include multiphase computed tomography urography (CTU) with corticomedullary phase, and urethrocystoscopy with cytology. If there is no clear diagnosis for clinical decision-making, ureterorenoscopy (URS) with focal cytology and biopsies should be performed. Both WHO classification systems (1973/1999 and 2004/2016) should be used. Novel biomarker tests are not yet widespread nor recommended for the detection of UTUC. Long-term, regular follow-up, including URS in patients who have had organ-sparing treatment, is important to check for tumour recurrences, intravesical recurrences, metastases and progression of the tumour.
Proper diagnostics with correct grading of UTUC are necessary for appropriate treatment decisions. The diagnostics should include CTU with corticomedullary phase, urine or bladder cytology, URS with focal barbotage cytology, and biopsies when needed for proper diagnosis and risk stratification. Regular, long-term follow-ups are fundamental, due to the high rate of recurrence and risk of progression.
World journal of urology. 2023 Aug 04 [Epub ahead of print]
Filip Sydén, Joyce Baard, Matthew Bultitude, Francis Xavier Keeley, Morgan Rouprêt, Kay Thomas, Tómas Andri Axelsson, Georg Jaremko, Helene Jung, Camilla Malm, Silvia Proietti, Palle Jørn Sloth Osther, Marianne Brehmer
Department of Urology, Stockholm South General Hospital, Stockholm, Sweden., Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Guy's and St. Thomas' NHS Foundation Trust, Urology Centre/Stone Unit, Guy's and St. Thomas' Hospital, London, UK., Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK., Sorbonne University, Pitié Salpétrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France., Department of Surgery and Urology, Danderyd Hospital, Stockholm, Sweden., Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden., Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark., Urology Department, San Raffaele Hospital, Milan, Italy., Department of Urology, Stockholm South General Hospital, Stockholm, Sweden. marianne.brehmer@ki.se.