{"id":331,"date":"2021-10-28T14:15:16","date_gmt":"2021-10-28T12:15:16","guid":{"rendered":"https:\/\/bcamonitor.org\/?p=331"},"modified":"2026-09-22T13:34:21","modified_gmt":"2026-09-22T13:34:21","slug":"using-urinary-markers-for-the-detection-of-upper-tract-urothelial-carcinoma","status":"publish","type":"post","link":"https:\/\/bcamonitor.org\/?p=331","title":{"rendered":"Using urinary markers for the detection of upper tract urothelial carcinoma"},"content":{"rendered":"

[et_pb_section fb_built=”1″ admin_label=”section” _builder_version=”4.16″ custom_padding=”0px|||||” global_colors_info=”{}” theme_builder_area=”post_content”][et_pb_row admin_label=”row” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_padding=”||4px|||” global_colors_info=”{}” theme_builder_area=”post_content”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||” theme_builder_area=”post_content”][et_pb_text admin_label=”Text” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” min_height=”280px” global_colors_info=”{}” theme_builder_area=”post_content”]Reviewed by\u00a0Mr. Hugh Mostafid<\/em><\/p>\n

\u201cAs EpiCheck\u00ae results are remarkable, this assay is now included in the diagnostic work-up of UTUC at our center.\u201d [1]<\/em><\/p>\n

Urothelial carcinomas are most commonly found in the bladder, in which case they are referred to as bladder cancer. However, they can also appear in the upper urinary tract, where they are called upper tract urothelial carcinomas (UTUC).<\/p>\n

For the diagnosis and staging of UTUC, the EAU guidelines recommend urethrocystoscopy to rule out a bladder tumour, urine cytology and a computed tomography (CT) urography. If imaging and cytology are not sufficient for the diagnosis and\/or risk-stratification of the tumour, the guidelines recommend using a diagnostic ureteroscopy and biopsy [2].<\/p>\n

Surveillance regimens of UTUC are also based on urethrocystoscopy and urinary cytology, and last for >5 years. Additionally, repeated ureteroscopy is recommended following kidney-sparing surgery, due to the high risk of disease recurrence [2].<\/p>\n

Detecting UTUC is challenging and burdensome.<\/strong> Cytology is even less sensitive for UTUC compared to bladder tumours [3] and carcinoma in situ (CIS) flat lesions are generally not visible with CT [2]. Ureteroscopies and biopsies are very invasive procedures, often failing to achieve definitive results and posing a significant burden on both patients and healthcare systems. Moreover, a diagnostic ureteroscopy before radical nephroureterectomy has been shown to be associated with a subsequent increase in bladder tumours [4,5].<\/p>\n

The performance of the EpiCheck\u00ae assay in detecting UTUC was evaluated in a single-centre, prospective trial led by Dr. Alberto Breda<\/strong>, head of the oncological urology unit and the kidney transplant team in Fundaci\u00f3 Puigvert, Barcelona, Spain [1]. In 80 patients with suspicion or in follow-up for UTUC, urine samples from the lower and upper tract were collected for urine cytology and EpiCheck\u00ae before a diagnostic ureteroscopy.[\/et_pb_text][et_pb_image src=”https:\/\/bcamonitor.org\/wp-content\/uploads\/2021\/10\/BCam_urinaryMarkers_fig1.jpg” title_text=”BCam_urinaryMarkers_fig1″ align=”center” _builder_version=”4.16″ width=”50%” global_colors_info=”{}” theme_builder_area=”post_content”][\/et_pb_image][et_pb_text _builder_version=”4.16″ _module_preset=”default” min_height=”24px” global_colors_info=”{}” theme_builder_area=”post_content”]<\/p>\n

The Bladder EpiCheck\u00ae assay achieved high sensitivity and high negative predictive value (NPV) for the detection of high-grade tumours compared to urine cytology<\/strong>. The test performance was better in urine samples collected from the upper tract than in samples collected from the lower tract. Specificity was favourable, allowing to exclude the vast majority of negative cases.<\/p>\n

[\/et_pb_text][et_pb_image src=”https:\/\/bcamonitor.org\/wp-content\/uploads\/2021\/10\/BCam_urinaryMarkers_fig2.jpg” title_text=”BCam_urinaryMarkers_fig2″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”|0px||250px||” global_colors_info=”{}” theme_builder_area=”post_content”][\/et_pb_image][et_pb_text _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}” theme_builder_area=”post_content”]Owing to these outstanding results, the oncological urology centre of Dr. Breda has included Bladder EpiCheck\u00ae in the diagnostic work-up of UTUC.<\/p>\n

A single-centre, prospective trial evaluating the performance of the Xpert\u00ae BC detection in 67 patients with suspicion of UTUC [6]. The sensitivity was higher with the Xpert\u00ae BC detection in both upper tract urine samples and in voided urine samples compared to urine cytology.<\/strong>[\/et_pb_text][et_pb_image src=”https:\/\/bcamonitor.org\/wp-content\/uploads\/2021\/10\/BCam_urinaryMarkers_fig3.jpg” title_text=”BCam_urinaryMarkers_fig3″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”|||250px||” global_colors_info=”{}” theme_builder_area=”post_content”][\/et_pb_image][et_pb_text admin_label=”Text” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_margin=”||0px||false|false” custom_padding=”||0px|||” global_colors_info=”{}” theme_builder_area=”post_content”]<\/p>\n

However, due to the cut-off for positivity (linear discriminant analysis [LDA]=0.45), the Xpert\u00ae BC detection specificity was low compared to cytology.<\/p>\n

 <\/p>\n

Conclusion<\/strong><\/p>\n

Both the Bladder EpiCheck\u00ae and the Xpert\u00ae BC detection urinary markers demonstrated high sensitivity for the detection of high-grade UTUC [1,4]. Additionally, the Bladder EpiCheck\u00ae demonstrated a high NPV for high-grade UTUC and high sensitivity, thereby ruling out high-grade tumours with a high level of confidence and providing a low rate of false positive results. Because of these excellent biomarker metrics, the Bladder EpiCheck\u00ae serves a useful tool for the detection of UTUC.<\/p>\n

Watch the presentation on the EpiCheck\u00ae assay here<\/a>.<\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.16″ global_colors_info=”{}” theme_builder_area=”post_content”][et_pb_column type=”4_4″ _builder_version=”4.16″ global_colors_info=”{}” theme_builder_area=”post_content”][et_pb_text _builder_version=”4.16″ global_colors_info=”{}” theme_builder_area=”post_content”]<\/p>\n

References<\/strong><\/p>\n

1. Gallioli A, Fontana M, Boissier R, et al. Presented at EAU 2021;abstract P0776.
2. Roupr\u00eat M, Babjuk M, Burger M, et al. European Association of Urology (EAU) 2021 guidelines on upper urinary tract urothelial carcinoma. Update April 2021.
3. Messer J, Shariat SF, Brien JC, et al. BJU Int 2011;108:701-5.
4. Marchioni M, Primiceri G, Luca Cindolo L, et al. BJU Int 2017;120:313-9.
5. Guo RQ, Hong P, Xiong GY, et al. BJU Int 2018;121:184-93.
6. D’Elia C, Trenti E, Folchini DM, et al. Presented at EAU 2021;abstract P0777.<\/p>\n

[\/et_pb_text][et_pb_button button_url=”https:\/\/bcamonitor.org\/slides-brochure\/” button_text=”Download the free slide resource and brochure” button_alignment=”center” _builder_version=”4.16″ custom_button=”on” button_text_color=”#ffffff” button_bg_color=”#3b8dbf” button_border_width=”0px” global_colors_info=”{}” theme_builder_area=”post_content”][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.8.2″ _module_preset=”default” custom_padding=”2px||5px|||” global_module=”303″ saved_tabs=”all” global_colors_info=”{}” theme_builder_area=”post_content”][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"

Reviewed by\u00a0Mr. Hugh Mostafid \u201cAs EpiCheck\u00ae results are remarkable, this assay is now included in the diagnostic work-up of UTUC at our center.\u201d [1] Urothelial carcinomas are most commonly found in the bladder, in which case they are referred to as bladder cancer. However, they can also appear in the upper urinary tract, where they […]<\/p>\n","protected":false},"author":0,"featured_media":196,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[8],"tags":[],"class_list":["post-331","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lecture"],"_links":{"self":[{"href":"https:\/\/bcamonitor.org\/index.php?rest_route=\/wp\/v2\/posts\/331","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bcamonitor.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bcamonitor.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/bcamonitor.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=331"}],"version-history":[{"count":1,"href":"https:\/\/bcamonitor.org\/index.php?rest_route=\/wp\/v2\/posts\/331\/revisions"}],"predecessor-version":[{"id":380,"href":"https:\/\/bcamonitor.org\/index.php?rest_route=\/wp\/v2\/posts\/331\/revisions\/380"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bcamonitor.org\/index.php?rest_route=\/wp\/v2\/media\/196"}],"wp:attachment":[{"href":"https:\/\/bcamonitor.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=331"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bcamonitor.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=331"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bcamonitor.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=331"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}