1036 Does Nephroureterectomy Decision Necessitates Prior Ureteric Biopsy in Cases with Upper Urothelial Tract Cancer?

Introduction Objective of study: assess need for ureteroscopic biopsy prior to nephroureterectomy (NU) for upper urothelial tract cancer (UTUC). Method Patients referred during 2015-2022 with suspected UTUC were included. Clinicopathological characteristics included presentation, CT results, urine cytology, ureteric biopsy and final histopathology. Analysis done using SPSS. Results Mode of presentation for 161 patients: 48% hematuria, 54 % CT filling defect, 8% ureteric thickening, 11% locally advanced and 17% inconclusive. Urine cytology was positive in 13% (n=21). 89 patients underwent nephroureterectomy. This cohort was subdivided into: Group1 with prior ureteric biopsy (n=39) and Group 2 without prior biopsy (n=50). Histopathological analysis comparison of NU specimen of two groups is shown in Table1. 4 patients in Group 1 and 10 in group 2 had histological diagnosis of disease other than UTUC suggesting that 10% of group 1 avoided NU while 20% of Group2 could have had alternative treatment than NU if they had prior biopsy. Amongst patients with prior biopsy, 5 had upstaging of histological grade on nephroureterectomy specimen. There was significant association (p=0.04) between histological grade on biopsy and NU specimen, especially in high grade disease. Conclusions Initial diagnostic ureteroscopy is useful in identifying UTUC requiring radical surgery and ruling out conditions which could be managed by alternative treatments. Prior Ureteroscopy may be avoided in patients with clear CT scan findings suggestive of UTUC associated with previous bladder cancer and/or abnormal urine cytology.