Diagnostic Accuracy of Liquid-Based Biomarkers for Detecting and Risk Stratifying Upper Tract Urothelial Cancers: A Diagnostic Test Systematic Review by the EAU Guidelines UTUC Panel - PubMed
3 days ago
- #UTUC diagnosis
- #Risk stratification
- #Liquid biomarkers
- Liquid-based biomarkers (LBBs) from urine and blood are emerging tools for diagnosing and risk stratifying upper tract urothelial carcinoma (UTUC).
- A systematic review of 32 studies from 2010-2024 evaluated LBBs, excluding urine cytology, for diagnostic accuracy and prediction of high-grade or ≥pT2 disease.
- Urine biomarkers like RNA panels, DNA methylation panels (e.g., GDF15, TMEFF2, VIM), Bladder Care Index, NRN1, ONECUT, and protein-based panels (BTA-STAT, BTA, survivin) showed favorable diagnostic profiles, though evidence certainty ranges from low to very low.
- Upper-tract urine assay EpiCheck demonstrated modest accuracy (sensitivity 65-83%, specificity 79-83%), but strong performance for high-grade disease.
- Blood biomarkers, particularly circulating tumor DNA (ctDNA) with plasma copy number burden >6.5, achieved high accuracy for predicting ≥pT2 and high-grade disease (sensitivity 71%, specificity 94%) with low certainty evidence.
- RNA, DNA methylation, protein-based, and ctDNA assays show promise, but current evidence is limited, requiring large prospective cohorts and biomarker-driven trials before clinical integration.