Abstract
Objectives To assess the performance of urine markers determined in urine samples from the bladder compared to samples collected from the upper urinary tract (UUT) for diagnosis of UUT urothelial carcinoma (UC). Patients and Methods The study comprised 758 urine samples either collected from the bladder (n = 373) or UUT (n = 385). All patients underwent urethrocystoscopy and UUT imaging or ureterorenoscopy. Cytology, fluorescence in situ hybridization (FISH), immunocytology (uCyt+), and nuclear matrix protein 22 (NMP22) were performed. Results UUT UC was diagnosed in 59 patients (19.1%) (UUT urine) and 27 patients (7.2%) (bladder-derived urine). For UUT-derived samples, sensitivities for cytology, FISH, NMP22, and uCyt+ were 74.6, 79.0, 100.0, and 100.0, while specificities were 66.6, 50.7, 5.9, and 66.7%, respectively. In bladder-derived samples, sensitivities were 59.3, 52.9, 62.5, and 50.0% whereas specificities were 82.9, 85.0, 31.3, and 69.8%. In UUT-derived samples, concomitant bladder cancer led to increased false-positive rates of cytology and FISH. Conclusions Urine markers determined in urine collected from the UUT exhibit better sensitivity but lower specificity compared to markers determined in bladder-derived urine. Concomitant or recent diagnosis of UC of the bladder can further influence markers determined in UUT urine.
Highlights
A high proportion of upper urinary tract (UUT) urothelial carcinomas (UC) (60%) are invasive at the time of diagnosis
CT urography plays a decisive role for detecting UUT UC, but flat lesions are commonly undetectable by CT urography until the development of a urothelial thickening [2, 3]
In 127 patients (16.8%), markers were tested during surveillance of urothelial carcinoma of the Cohort with markers Cohort with markers determined in determined in UUT-derived urine, n (%) voided urine, n (%)
Summary
A high proportion of upper urinary tract (UUT) urothelial carcinomas (UC) (60%) are invasive at the time of diagnosis. The diagnosis of UUT UC, especially in early stages, is difficult and in many cases fortuitous. Typical symptoms like hematuria and flank pain are unspecific, and a lumbar mass is only detectable in 10–20% of all cases and reflects an advanced tumor stage [1, 2]. CT urography plays a decisive role for detecting UUT UC, but flat lesions are commonly undetectable by CT urography until the development of a urothelial thickening [2, 3]. Flexible ureteroscopy of the upper tract is considered as a major tool for diagnosis of UUT UC, and a ureteroscopic biopsy can determine tumor grade with a low false-negative rate [4]. Additional cystoscopy is required to rule out a UC in the bladder or the prostatic urethra [2]
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