From the Research
For the evaluation of upper tract urothelial carcinoma (UTUC), the most recommended tumor markers are urine cytology and fluorescence in situ hybridization (FISH) testing, with the combination of Survivin + BTA + Cytology being the most promising model for discriminating UTUC from controls. The selection of appropriate markers depends on clinical context, with some being more useful for initial diagnosis while others are better suited for monitoring recurrence or progression 1. Urine cytology is the most widely used and valuable marker, with high specificity for high-grade tumors though lower sensitivity for low-grade lesions 2. FISH testing can detect chromosomal abnormalities associated with UTUC and is particularly useful when cytology results are inconclusive 3. Nuclear matrix protein 22 (NMP22) and bladder tumor antigen (BTA) tests may be used as complementary tools, though they have limited specificity 1. Newer molecular markers include FGFR3 mutation analysis, which is associated with lower-grade tumors, and microsatellite analysis to detect genetic instability. Immunohistochemical markers such as CK20, p53, and Ki-67 can help assess tumor aggressiveness when tissue samples are available. These markers should be used in conjunction with imaging studies and endoscopic evaluation, not as standalone diagnostic tools 4. According to the most recent study, the triple combination of Survivin + BTA + Cytology was the most promising model for discriminating UTUC from controls, with an area under the curve value of 0.97, sensitivity of 86%, and specificity of 96% 1.
Some key points to consider when evaluating UTUC include:
- The importance of combining different diagnostic modalities to improve sensitivity and specificity
- The role of urine cytology and FISH testing in the initial diagnosis and monitoring of UTUC
- The potential benefits of newer molecular markers, such as FGFR3 mutation analysis and microsatellite analysis, in assessing tumor aggressiveness and guiding treatment decisions
- The need for imaging studies and endoscopic evaluation to provide a comprehensive assessment of the tumor and guide treatment decisions 5.
Overall, the evaluation of UTUC requires a multifaceted approach that incorporates a range of diagnostic modalities and markers to provide accurate diagnosis and effective treatment. The most recent and highest quality study 1 provides the best evidence for the use of the combination of Survivin + BTA + Cytology in the evaluation of UTUC.