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Biopsietechniken im oberen Harntrakt zur Diagnostik des Urothelkarzinoms: systematische Übersicht

Biopsy techniques in the upper urinary tract for the diagnosis of urothelial carcinoma: systematic review

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Zusammenfassung

Hintergrund

Die diagnostische Genauigkeit von Biopsien des oberen Harntraktes ist durch technische Schwierigkeiten bei der Entnahme und die geringe Größe der Präparate limitiert.

Fragestellung

Der Einfluss verschiedener Biopsietechniken und Instrumente auf die histopathologische Qualität und Diagnosefähigkeit der entnommenen Proben sowie der prädiktive Wert des klinischen Gradings und Stagings der Biopsie bezüglich des definitiven pathologischen Tumorstadiums nach radikaler Nephroureterektomie werden dargestellt.

Material und Methode

Für diese Übersichtsarbeit wurden die Datenbanken PubMed und EMBASE systematisch nach Originalarbeiten und Abstracts von Kongressbeiträgen gemäß den PRISMA-Leitlinien durchsucht.

Ergebnisse

Es wurden 23 Studien mit insgesamt 1547 Biopsien für die Beurteilung der Diagnosefähigkeit und 778 Patienten für die Grade- und Stage-Konkordanz eingeschlossen. Eine Diagnosestellung war mit den großen retrograden 2‑F‑Zangen im Median bei 92 % (Range 83–100 %), den antegraden 3‑F-Zangen bei 71 % (50–90 %) und den Körbchen in Kombination mit 3‑F-Zangen bei 91 % (78–94 %) der Biopsien möglich. Die medianen Raten der Grade-Konkordanz und des Upgradings lagen bei allen Techniken im Bereich von 78–89 % bzw. 5–16 % und wiesen keine relevanten Unterschiede zwischen den verschiedenen Techniken auf.

Schlussfolgerung

Die Wahl der Biopsietechnik beeinflusst die Fähigkeit zur Diagnosestellung des Urothelkarzinoms. Die korrekte Einschätzung des pathologischen Gradings ist mit den unterschiedlichen Techniken vergleichbar. Die Kombination von Zangen und Dormia-Körbchen scheint die bestmögliche diagnostische Genauigkeit zu bieten.

Abstract

Background

The diagnostic accuracy of ureteroscopic biopsies in the upper urinary tract is limited by technical difficulties during extraction and small sample size.

Objectives

To evaluate the impact of different techniques and instruments on the histopathologic quality and diagnostic yield of extracted samples as well as the predictive value of clinical grading and staging on final pathologic stage at radical nephroureterectomy.

Materials and methods

For this systematic review, we searched PubMed and Embase databases for original publications and meeting abstracts according to the PRISMA guidelines.

Results

Overall, we included 23 studies which comprised a total of 1547 biopsies for the investigation of diagnostic yield and 778 patients for the assessment of grade and stage concordance. We found that the median diagnostic yields of big retrograde 2F [french] forceps, antegrade 3F forceps and baskets in combination with forceps were 92% (range 83–100), 72% (50–90) and 91% (78–94), respectively. Median rates of grade concordance and upgrading across all techniques ranged between 78–89% and 5–16%, respectively, without relevant differences.

Conclusions

The choice of biopsy technique affects the ability to diagnose upper tract urothelial carcinoma. The correct determination of pathologic grading is comparable between different techniques. The combination of biopsy forceps and baskets during ureterorenoscopy seems to achieve optimal diagnostic accuracy.

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Authors and Affiliations

  1. Universitätsklinik für Urologie, Medizinische Universität Wien, Wien, Österreich

    B. Foerster & S. F. Shariat

  2. Klinik für Urologie, Kantonsspital Winterthur, Winterthur, Schweiz

    B. Foerster

  3. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, USA

    S. F. Shariat

  4. Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA

    S. F. Shariat

  5. Karl Landsteiner Institut für Urologie und Andrologie, Wien, Österreich

    S. F. Shariat

  6. Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland

    J. T. Klein &  C. Bolenz

Authors
  1. B. Foerster
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  2. S. F. Shariat
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  3. J. T. Klein
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  4. C. Bolenz
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Corresponding author

Correspondence to C. Bolenz.

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Interessenkonflikt

J.T. Klein und C. Bolenz führen Beratungstätigkeiten für die Firma Erbe Elektromedizin GmbH, Tübingen, durch und erhalten Studienunterstützungen. S.F. Shariat besitzt folgende Patente: „Methods to determine prognosis after therapy for prostate cancer“, bewilligt am 6. September 2002; „Methods to determine prognosis after therapy for bladder cancer“, bewilligt am 19. Juni 2003; „Prognostic methods for patients with prostatic disease“ bewilligt am 5. August 2004; und „Soluble Fas:urinary marker for the detection of bladder transitional cell carcinoma“, bewilligt am 20. Juli 2010; Er ist „Advisory Board Member“ für Astellas, Cepheid, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanofi und Wolff; und „Speaker“ für Astellas, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanochemia, Sanofi und Wolff. B. Foerster gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Foerster, B., Shariat, S.F., Klein, J.T. et al. Biopsietechniken im oberen Harntrakt zur Diagnostik des Urothelkarzinoms: systematische Übersicht. Urologe 58, 14–21 (2019). https://doi.org/10.1007/s00120-018-0829-6

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  • DOI: https://doi.org/10.1007/s00120-018-0829-6

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