{"id":348,"date":"2025-06-13T17:09:44","date_gmt":"2025-06-13T15:09:44","guid":{"rendered":"https:\/\/bcamonitor.org\/?p=348"},"modified":"2026-09-22T13:30:52","modified_gmt":"2026-09-22T13:30:52","slug":"implementing-urinary-biomarkers-in-nmibc-surveillance","status":"publish","type":"post","link":"https:\/\/bcamonitor.org\/?p=348","title":{"rendered":"Implementing urinary biomarkers in NMIBC surveillance"},"content":{"rendered":"

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Key perspectives from the EAU guidelines panel<\/h1>\n

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Reviewed by Paolo Gontero<\/em><\/p>\n

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The current standard-of-care for NMIBC surveillance<\/strong><\/h4>\n

The 2025 EAU guidelines recommend cystoscopy as standard-of-care for the surveillance of all patients with non-muscle-invasive bladder cancer (NMIBC) [1]. However, cystoscopy is an invasive procedure that many patients find burdensome. While some non-invasive urinary biomarkers are commercially available, HCPs face difficulties in interpreting the data and translating it to clinical practice. To address this, the EAU guidelines panel published an article to shed some light into their clinical implementation.<\/p>\n

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Key characteristics of urinary biomarkers<\/strong><\/h4>\n

Four key outcomes are commonly measured to evaluate the utility of urinary biomarkers in the detection of NMIBC recurrence during surveillance: sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) [2].<\/p>\n\n\n\n\n
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Image modified from Monaghan TF, et al. Medicina (Kaunas) 2021 [3].<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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To safely postpone or replace cystoscopy (rule out), urinary biomarkers should have high sensitivity, specificity and NPV [2]. Of importance, NPV, as well as PPV, are influenced by the prevalence of disease recurrence<\/strong>, which should therefore be considered when interpreting the clinical usefulness of biomarkers. This was clarified in the article with an example of a urinary biomarker that fails to detect any recurrences in a cohort where 15% of patients actually experience recurrence, resulting in an NPV of 85% despite lacking clinical utility.<\/p>\n

Besides these common performance measurements, the EAU guidelines panel also recommends using the likelihood ratio, a coefficient that evaluates biomarker accuracy. The likelihood ratio reflects the magnitude a biomarker result can improve the probability of ruling in or ruling out the presence of bladder cancer. It is calculated as follows [2,4]:<\/p>\n

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Positive likelihood ratios of >10 provide strong evidence for rule in <\/strong>(positive test is associated with the presence of disease), while negative likelihood ratios of <0.1 are strong indicators for rule out <\/strong>(negative test reliably excludes the presence of disease) [2,4]. Despite being considered as an important measurement, it is often not reported.<\/p>\n

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Translating urinary biomarker data into clinical practice<\/strong><\/h4>\n

The clinical utility of implementing urinary biomarkers varies depending on the patient risk category and the biomarker performance:<\/p>\n