Editing Upper Urinary Tract Urothelial Cancer (section)

=== Labs ===

==== <span style="color:#ff0000">Selective ipsilateral upper tract urine cytology</span> ====
*'''Provides supplemental histologic data to tumor biopsies'''
**'''High-grade cytology in the setting of low-grade biopsy findings indicates the likely presence of higher-risk features (e.g., high-grade tumor) missed on biopsy sampling.'''
*Reported according to 7 categories (Paris System):
*#Non-diagnostic
*#Negative for high-grade urothelial carcinoma
*#Atypical urothelial cells
*#Suspicious for high-grade urothelial carcinoma
*#High-grade urothelial carcinoma
*#Low-grade urothelial neoplasm
*#Other malignancies
*'''<span style="color:#ff0000">Test characteristics[https://pubmed.ncbi.nlm.nih.gov/27151340/]</span>'''
**'''High specificity (≈90% with selective cytology)'''
**'''Low sensitivity (≈50% with selective cytology)'''
***'''Sensitivity of cytology is directly related to tumor grade'''
*'''<span style="color:#ff0000">Specimen collection considerations</span>'''
**'''<span style="color:#ff0000">Causes of false-positive cytology (2):</span>'''
**# '''<span style="color:#ff0000">Contrast agents</span>'''
**#* Exposure of urothelial cells to ionic, high-osmolar contrast agents as in retrograde pyelography may worsen cytologic abnormalities. 
**#**'''<span style="color:#ff0000">Cytology should be collected prior to any contrast use to avoid artifactual cellular changes from contrast solutions</span>'''
**# '''Inflammation from infection or stones'''
**'''<span style="color:#ff0000">Can be obtained as selective vs. voided urinary specimen</span>'''
***'''<span style="color:#ff0000">Selective cytology</span>''' 
****'''<span style="color:#ff0000">Obtained either as barbotage (saline irrigation and aspiration) or by saline irrigation with passive collection (washings)</span>'''
*****'''<span style="color:#ff0000">Collecting selective cytology after tumor biopsy can improve the yield of cells for cytologic analysis.</span>'''
****'''Preferred over a voided urinary specimen''', due to (3)
****#Improve cellular yield
****#Avoid potential contamination in case of concomitant bladder and/or prostatic urethral disease
****#Avoid theoretical dilution of the specimen from a normal contralateral unit
**'''In a patient with an upper tract filling defect and an abnormal voided cytology, must be cautious in determining the site of origin of the malignant cells'''. Ureteral catheterization for collection of urine or washings may provide more accurate cytologic results.

==== <span style="color:#ff0000">Assessment of renal function</span> ====
*Can help with patient counseling, strategizing treatment sequence (operative approach and administration of systemic therapy), and determination of downstream risks of CKD and potential dialysis.
* '''<span style="color:#ff0000">Recommended test: serum creatinine (to calculate an eGFR)'''
**For more refined evaluation, split function testing such as with differential renal scan or CT volumetric studies may be considered.
**The two formulas for monitoring eGFR commonly reported in the contemporary literature at this time are the [https://www.mdcalc.com/calc/76/mdrd-gfr-equation Modification of Diet in Renal Disease] and [https://www.mdcalc.com/calc/3939/ckd-epi-equations-glomerular-filtration-rate-gfr CKD – Epidemiology Collaboration (CKD-EPI)] equations.
*'''<span style="color:#ff0000">UTUC with associated hydronephrosis'''
**'''Implications on assessment of renal function'''
*** Caused by tumor obstruction may falsely under-estimate preoperative renal function and alter decision-making around the use of neoadjuvant chemotherapy (NAC).
*** Atrophy of the contralateral (unaffected) renal unit may lead to over-estimates of postoperative renal function in the setting of NU since the kidney with lower differential function will remain in situ
**'''Renal decompression either by indwelling ureteric stent or a percutaneous nephrostomy tube placed in an uninvolved renal calyx along with oral fluid hydration for 7-14 days before re-checking eGFR will help to establish a more accurate estimation of baseline renal function.'''
***'''<span style="color:#ff0000">Ureteric stenting is the preferred method of drainage'''
****Percutaneous nephrostomy tubes in the setting of UTUC increases risk of tract seeding and has worse quality of life

==== Liver function tests ====
* Liver is a common site of metastasis