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  • 1.
    Fojecki, Grzegorz
    et al.
    Hosp Southern Jutland, Dept Urol, Sonderborg, Denmark.
    Magnusson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Traxer, Olivier
    Sorbonne Univ, Hop Tenon, Paris, France.
    Baard, Joyce
    Univ Amsterdam, Dept Urol, Amsterdam UMC, Amsterdam, Holland, Netherlands.
    Osther, Palle Jörn Sloth
    Univ Southern Denmark, Lillebaelt Hosp, Urol Res Ctr, Vejle, Denmark.
    Jaremko, Georg
    Karolinska Univ Hosp Solna, Dept Clin Pathol & Cytol, Stockholm, Sweden.
    Seitz, Christian
    Med Univ Vienna, Dept Urol, Vienna, Austria.
    Knoll, Thomas
    Teaching Hosp Univ Tuebingen, Dept Urol, Sindelfingen, Germany.
    Giusti, Guido
    IRCCS San Raffaele Hosp, Dept Urol, Ville Turro Div, Milan, Italy.
    Brehmer, Marianne
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Div Urol, Stockholm, Sweden.
    Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper tract urothelial carcinoma2019In: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726, Vol. 37, no 11, p. 2271-2278Article in journal (Refereed)
    Abstract [en]

    Purpose: To summarize knowledge on upper urinary tract carcinoma (UTUC) regarding diagnostic procedures, risk factors and prognostic markers.

    Methods: A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC in Stockholm, September 2018.

    Results: Tumor stage and grade are the most important prognostic factors. CT urography (CTU) including corticomedullary phase is the preferred imaging modality. A clear tumor on CTU in combination with high-grade UTUC in urine cytology identifies high-risk UTUC, and in some cases indirect staging can be obtained. Bladder urine cytology has limited sensitivity, and in most cases ureterorenoscopy (URS) with in situ samples for cytology and histopathology are mandatory for exact diagnosis. Image-enhancing techniques, Image S1 and narrow-band imaging, may improve tumor detection at URS. Direct confocal laser endomicroscopy may help to define grade during URS. There is strong correlation between stage and grade, accordingly correct grading is crucial. The correlation is more pronounced using the 1999 WHO than the 2004 classification: however, the 1999 system risks greater interobserver variability. Using both systems is advisable. A number of tissue-based molecular markers have been studied. None has proven ready for use in clinical practice.

    Conclusions: Correct grading and staging of UTUC are mandatory for adequate treatment decisions. Optimal diagnostic workup should include CTU with corticomedullary phase, URS with in situ cytology and biopsies. Both WHO classification systems (1999 and 2004) should be used to decrease risk of undergrading or overtreatment.

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