Editing Upper Urinary Tract Urothelial Cancer (section)

== Risk-Stratification of Localized UTUC ==

=== AUA ===

* [https://pubmed.ncbi.nlm.nih.gov/37096584/ '''2023 AUA Guidelines on Upper Tract Urothelial Carcinoma''']
** '''<span style="color:#ff0000">Categorized as high- vs. low-risk</span>''' of disease progression and pathologic stage ≥T2 disease
***'''<span style="color:#ff0000">Based on biopsy grade</span>'''
****Association of high grade tumor on ureteroscopic biopsy with high-stage disease (≥pT2) on final pathology
*****Positive predictive value: 60%
*****Negative predictive value:77%
***'''<span style="color:#ff0000">Sub-stratified into favorable vs. unfavorable (see [https://www.auajournals.org/doi/10.1097/JU.0000000000003480 Table 4]), based on (4):</span>'''
***#'''<span style="color:#ff0000">Cytology</span>'''
***#'''<span style="color:#ff0000">Radiographic appearance</span>'''
***#*'''<span style="color:#ff0000">Multifocality</span>'''
***#*'''<span style="color:#ff0000">Size</span>'''
***#*'''<span style="color:#ff0000">Invasive features</span>'''
***#**Heterogenous texture on enhanced and even unenhanced CT imaging has been associated with invasive disease
***#*'''<span style="color:#ff0000">Obstruction of the urinary tract</span>'''
***#*'''<span style="color:#ff0000">Locoregional progression such as suspicious lymphadenopathy</span>'''
***#*'''<span style="color:#ff0000">Presence of metastatic disease</span>'''
***#'''<span style="color:#ff0000">Endoscopic appearance</span>'''
***#*'''<span style="color:#ff0000">Appearance (sessile, papillary, flat/villous)</span>'''
***#*'''<span style="color:#ff0000">Multifocality</span>'''
***#*'''<span style="color:#ff0000">Size</span>'''
***#**Tumors ≥ 1.5 cm in size are associated with a > 80% risk of invasive disease
***#**Measurement in the pre-surgical setting is not standardized and has not been shown to be independent of other more easily determined clinically identified features such as multifocality, invasion and obstruction.
***#'''<span style="color:#ff0000">Lower tract involvement</span>'''
***#*'''Pan-urothelial disease as indicated by history of prior cystectomy, concomitant or metachronous lower tract urothelial cancer or contralateral UTUC diagnosis'''