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Nichtinvasive Urindiagnostik des Harnblasenkarzinoms

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Zusammenfassung

Obwohl das derzeitige Klassifikationssystem von Harnblasenkarzinomen durch Tumorstadium und -differenzierungsgrad nützliche Informationen leistet, kann der natürliche Verlauf der Erkrankung mit oder ohne Therapie nur eingeschränkt prognostiziert werden. Die Zystoskopie und Urinzytologie sind derzeit als "golden standard" in der Diagnostik und Überwachung des Harnblasenkarzinoms anzusehen. Die klassische Urinzytologie ist jedoch zumindest beim G1-Karzinom durch eine relativ niedrige Sensitivität gekennzeichnet und unterliegt einer deutlichen Untersucherabhängigkeit. Durch die Erforschung der molekularbiologischen Grundlagen der Karzinogenese wurde eine Vielzahl potenziell diagnostischer oder prognostischer Marker für das Harnblasenkarzinom beschrieben. In der vorliegenden Übersichtsarbeit wurde die Literatur zu den verschiedenen Tumormarkern des Harnblasenkarzinoms im Hinblick auf deren diagnostische Wertigkeit aktuell und umfassend dargestellt.

Unter der Prämisse, dass die Zystoskopie selbst nie evaluiert wurde, besteht zusammenfassend derzeit kein diagnostischer Marker, der eine vergleichbare Sensitivität und Spezifität wie die Zystoskopie besitzt und diese ersetzen könnte. Unter den diagnostischen Markern scheint der kombinierte Nachweis mehrerer Tumorantigene als Ergänzung zur Zystoskopie am vielversprechendsten zu sein. Zudem wird die zunehmende Vereinfachung der Testsysteme die Akzeptanz des Klinikers weiter erhöhen.

Abstract

Although the current system of classifying bladder cancer by stage and histological grade is very useful, it is still difficult to predict the natural progression of the disease either with or without therapy. Cystoscopy and urine cytology are currently the gold standards in the monitoring and diagnosis of bladder cancer. Classical urine cytology is, however, at least in the diagnosis of G1-tumors, characterized by a relatively low sensitivity. In the last few years, the molecular biological investigation of the basic mechanisms involved in carcinogenesis has provided a host of markers which are of potential diagnostic value for bladder cancer. We provide a current, comprehensive review of the literature on bladder tumor markers and summarize their diagnostic and prognostic potential.

At present, no diagnostic marker with a comparable sensitivity and specifity to cystoscopy exists, given that cystoscopy has never been evaluated. The combined analysis of several tumor markers seems to be the most promising approach as an adjunct to cystoscopy. Moreover, the increasing simplification of test systems will increase their acceptance by clinicians.

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  1. Urologische Klinik und Poliklinik, Medizinische Universität zu Lübeck

    I. Kausch &  A. Böhle

  2. HELIOS Agnes Karll Krankenhaus, Am Hochkamp 21, 23611, Bad Schwartau

    A. Böhle

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Kausch, I., Böhle, A. Nichtinvasive Urindiagnostik des Harnblasenkarzinoms. Urologe [A] 42, 912–921 (2003). https://doi.org/10.1007/s00120-003-0307-6

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