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Guidelines

Upper Urinary Tract Urothelial Cell Carcinoma

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  1. Introduction
  2. Methods
  3. Epidemiology Aetiology And Pathology
  4. Staging And Classification Systems
  5. Diagnosis
  6. Risk Stratification
  7. Disease Management
  8. Follow Up
  9. Quality Indicators For The Management Of Utuc
  10. References
  11. Conflict Of Interest
  12. Citation Information
  13. Copyright And Terms Of Use
4. Staging And Classification Systems
  • 1. Introduction
  • 2. Methods
  • 3. Epidemiology Aetiology And Pathology
  • 4. Staging And Classification Systems
  • 5. Diagnosis
  • 6. Risk Stratification
  • 7. Disease Management
  • 8. Follow Up
  • 9. Quality Indicators For The Management Of Utuc
  • 10. References
  • 11. Conflict Of Interest
  • 12. Citation Information
  • 13. Copyright And Terms Of Use
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4. STAGING AND CLASSIFICATION SYSTEMS

4.1. Classification

The classification and morphology of UTUC and BC are similar [1]. However, because of the difficulty in adequate sample acquisition, it is often difficult to distinguish between non-invasive papillary tumours [86], flat lesions (carcinoma in situ [CIS]), and invasive carcinoma in biopsies. Therefore, histological grade is often used for clinical decision making as it is strongly associated with pathological stage [87].

4.2. Tumour Node Metastasis staging

The Tumour, Node, Metastasis (TNM) classification is shown in Table 1 [88]. The regional lymph nodes (LNs) are the hilar and retroperitoneal nodes and, for the mid- and distal ureter, the pelvic nodes. Laterality does not affect N classification.

4.3. Tumour grade

In 2004 and 2022, the WHO published a new histological classification of UCs which provides a different patient stratification between individual categories compared to the older 1973 WHO classification [89-91]. These guidelines are still based on both the 1973 and 2004/2016 WHO classifications since most published data use the 1973 classification [86].

Table 1: TNM classification 2017 for upper tract urothelial cell carcinoma [88]

TNM classification 2017 for upper tract urothelial cell carcinoma
T - Primary tumour
TXPrimary tumour cannot be assessed
T0No evidence of primary tumour
 TaNon-invasive papillary carcinoma
 TisCarcinoma in situ
T1Tumour invades subepithelial connective tissue
T2Tumour invades muscularis
T3(Renal pelvis) Tumour invades beyond muscularis into peripelvic fat or renal parenchyma 
(Ureter) Tumour invades beyond muscularis into periureteric fat
T4Tumour invades adjacent organs or through the kidney into perinephric fat
N - Regional lymph nodes
NXRegional lymph nodes cannot be assessed
N0No regional lymph node metastasis
N1Metastasis in a single lymph node 2 cm or less in the greatest dimension
N2Metastasis in a single lymph node more than 2 cm, or multiple lymph nodes
M - Distant metastasis
M0No distant metastasis
M1Distant metastasis
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