Skip to main content
SpringerLink
Log in

Urinmarkersysteme zur Diagnostik des Urothelkarzinoms

Urine marker systems for diagnosis of urothelial cancer

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die Standardverfahren bei der Diagnostik des Urothelkarzinoms der Harnblase sind die Zystoskopie und die Urinzytologie. Doch die Zystoskopie ist ein invasives Verfahren und die Zytologie ist unsicher in der Diagnostik von Low-grade-Karzinomen. Daher wurden in den letzten Jahren eine ganze Reihe verschiedener uringebundener Tumortestverfahren entwickelt um die Diagnose dieses häufigen Tumors zu vereinfachen. Insgesamt leiden aber die kommerziell erhältlichen Schnelltestverfahren unter einer hohen Rate an falsch-positiven Ergebnissen insbesondere beim Vorliegen benigner Erkrankungen. Ein sinnvoller Zusatz zur Standarddiagnostik kann hingegen die Fluoreszenz-in-situ-Hybridisierung darstellen, die hoch spezifisch ist und auch in Situationen nach Instillationstherapie oder Harnableitung eine zuverlässige Tumordiagnostik ermöglicht. In der präklinischen Erprobung findet sich eine Reihe neuer Verfahren, deren klinischer Wert aber noch in größeren Studien überprüft werden muss.

Abstract

Cystoscopy and urinary cytology are standard tools in the diagnostics of urothelial cancer of the urinary bladder; however, cystoscopy is invasive and urinary cytology lacks accuracy for the diagnosis of low grade tumors. More recently several alternative urinary test systems were developed with the aim to make the diagnostics of urothelial tumors more reliable; however, in general all protein-based point of care test systems have a high rate of false positive test results, especially in patients with benign disorders. Fluorescence in situ hybridization, which is highly sensitive and specific, may be a reasonable supplement to the diagnostic spectrum in patients after instillation therapy or bladder replacement. Additionally, there are several new test systems which still need to be tested in large clinical studies with respect to diagnostic accuracy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. CA Cancer J Clin 63:11–30

    Article  PubMed  Google Scholar 

  2. Babjuk M, Oosterlinck W, Sylvester R et al (2011) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 59:997–1008

    Article  PubMed  Google Scholar 

  3. Bangma CH, Loeb S, Busstra M et al (2013) Outcomes of a bladder cancer screening program using home hematuria testing and molecular markers. Eur Urol (Epub ahead of print). doi: 10.1016/j.eururo.2013.02.036

  4. Zaak D, Hungerhuber E, Schneede P et al (2002) Role of 5-aminolevulinic acid in the detection of urothelial premalignant lesions. Cancer 95:1234–1238

    Article  PubMed  Google Scholar 

  5. Tritschler S, Sommer ML, Straub J et al (2010) Urinary cytology in era of fluorescence endoscopy: redefining the role of an established method with a new reference standard. Urology 76(3):677–680

    Article  PubMed  Google Scholar 

  6. Tilki D, Burger M, Dalbagni G et al (2011) Urine markers for detection and surveillance of non-muscle-invasive bladder cancer. Eur Urol 60:484–492

    Article  PubMed  Google Scholar 

  7. Strittmatter F, Buchner A, Karl A et al (2011) Individual learning curve reduces the clinical value of urinary cytology. Clin Genitourin Cancer 9:22–26

    Article  PubMed  Google Scholar 

  8. Raitanen MP, Aine R, Rintala E et al (2002) Differences between local and review urinary cytology in diagnosis of bladder cancer. An interobserver multicenter analysis. Eur Urol 41:284–289

    Article  PubMed  Google Scholar 

  9. Tritschler S, Karl A, Sommer ML et al (2010) Influence of clinical information on the interpretation of urinary cytology in bladder cancer: how suggestible is a cytologist? BJU Int 106:1165–1168

    Article  PubMed  Google Scholar 

  10. Rhijn BW van, Poel HG van der, Kwast TH van der (2005) Urine markers for bladder cancer surveillance: a systematic review. Eur Urol 47:736–748

    Article  PubMed  Google Scholar 

  11. Bastacky S, Ibrahim S, Wilczynski SP, Murphy WM (1999) The accuracy of urinary cytology in daily practice. Cancer 87:118–128

    Article  PubMed  CAS  Google Scholar 

  12. Planz B, Jochims E, Deix T et al (2005) The role of urinary cytology for detection of bladder cancer. Eur J Surg Oncol 31:304–308

    Article  PubMed  CAS  Google Scholar 

  13. Lotan Y, Roehrborn CG (2003) Sensitivity and specificity of commonly available bladder tumor markers versus cytology: results of a comprehensive literature review and meta-analyses. Urology 61:109–118

    Article  PubMed  Google Scholar 

  14. Sharma S, Zippe CD, Pandrangi L et al (1999) Exclusion criteria enhance the specificity and positive predictive value of NMP22 and BTA stat. J Urol 162:53–57

    Article  PubMed  CAS  Google Scholar 

  15. Tritschler S, Scharf S, Karl A et al (2007) Validation of the diagnostic value of NMP22 BladderChek test as a marker for bladder cancer by photodynamic diagnosis. Eur Urol 51:403–407

    Article  PubMed  CAS  Google Scholar 

  16. Shariat SF, Savage C, Chromecki TF et al (2011) Assessing the clinical benefit of nuclear matrix protein 22 in the surveillance of patients with nonmuscle-invasive bladder cancer and negative cytology: a decision-curve analysis. Cancer 117:2892–2897

    Article  PubMed  CAS  Google Scholar 

  17. Barbieri CE, Cha EK, Chromecki TF et al (2012) Decision curve analysis assessing the clinical benefit of NMP22 in the detection of bladder cancer: secondary analysis of a prospective trial. BJU Int 109:685–690

    Article  PubMed  Google Scholar 

  18. Oge O, Kozaci D, Gemalmaz H (2002) The BTA stat test is nonspecific for hematuria: an experimental hematuria model. J Urol 167:1318–1319

    Article  PubMed  Google Scholar 

  19. Nasuti JF, Gomella LG, Ismial M, Bibbo M (1999) Utility of the BTA stat test kit for bladder cancer screening. Diagn Cytopathol 21:27–29

    Article  PubMed  CAS  Google Scholar 

  20. Halling KC (2003) Vysis UroVysion for the detection of urothelial carcinoma. Expert Rev Mol Diagn 3:507–519

    Article  PubMed  Google Scholar 

  21. Fernandez MI, Parikh S, Grossman HB et al (2012) The role of FISH and cytology in upper urinary tract surveillance after radical cystectomy for bladder cancer. Urol Oncol 30:821–824

    Article  PubMed  CAS  Google Scholar 

  22. Skacel M, Fahmy M, Brainard JA et al (2003) Multitarget fluorescence in situ hybridization assay detects transitional cell carcinoma in the majority of patients with bladder cancer and atypical or negative urine cytology. J Urol 169:2101–2105

    Article  PubMed  CAS  Google Scholar 

  23. Gofrit ON, Zorn KC, Silvestre J et al (2008) The predictive value of multi-targeted fluorescent in-situ hybridization in patients with history of bladder cancer. Urol Oncol 26:246–249

    Article  PubMed  CAS  Google Scholar 

  24. Sarosdy MF, Schellhammer P, Bokinsky G et al (2002) Clinical evaluation of a multi-target fluorescent in situ hybridization assay for detection of bladder cancer. J Urol 168:1950–1954

    Article  PubMed  CAS  Google Scholar 

  25. Olsson H, Zackrisson B (2001) ImmunoCyt a useful method in the follow-up protocol for patients with urinary bladder carcinoma. Scand J Urol Nephrol 35:280–282

    Article  PubMed  CAS  Google Scholar 

  26. Hautmann S, Toma M, Lorenzo Gomez MF et al (2004) Immunocyt and the HA-HAase urine tests for the detection of bladder cancer: a side-by-side comparison. Eur Urol 46:466–471

    Article  PubMed  Google Scholar 

  27. Roupret M, Hupertan V, Yates DR et al (2008) A comparison of the performance of microsatellite and methylation urine analysis for predicting the recurrence of urothelial cell carcinoma, and definition of a set of markers by Bayesian network analysis. BJU Int 101:1448–1453

    Article  PubMed  Google Scholar 

  28. Oers JM van, Lurkin I, Exsel AJ van et al (2005) A simple and fast method for the simultaneous detection of nine fibroblast growth factor receptor 3 mutations in bladder cancer and voided urine. Clin Cancer Res 11:7743–7748

    Article  PubMed  Google Scholar 

  29. Babjuk M, Kostirova M, Mudra K et al (2002) Qualitative and quantitative detection of urinary human complement factor H-related protein (BTA stat and BTA TRAK) and fragments of cytokeratins 8, 18 (UBC rapid and UBC IRMA) as markers for transitional cell carcinoma of the bladder. Eur Urol 41:34–39

    Article  PubMed  CAS  Google Scholar 

  30. Hakenberg OW, Fuessel S, Richter K et al (2004) Qualitative and quantitative assessment of urinary cytokeratin 8 and 18 fragments compared with voided urine cytology in diagnosis of bladder carcinoma. Urology 64:1121–1126

    Article  PubMed  Google Scholar 

  31. Konety BR, Nguyen TS, Dhir R et al (2000) Detection of bladder cancer using a novel nuclear matrix protein, BLCA-4. Clin Cancer Res 6:2618–2625

    PubMed  CAS  Google Scholar 

  32. Van Le TS, Miller R, Barder T et al (2005) Highly specific urine-based marker of bladder cancer. Urology 66:1256–1260

    Article  Google Scholar 

  33. Myers-Irvin JM, Landsittel D, Getzenberg RH (2005) Use of the novel marker BLCA-1 for the detection of bladder cancer. J Urol 174:64–68

    Article  PubMed  CAS  Google Scholar 

  34. Margulis V, Lotan Y, Shariat SF (2008) Survivin: a promising biomarker for detection and prognosis of bladder cancer. World J Urol 26:59–65

    Article  PubMed  CAS  Google Scholar 

  35. Shariat SF, Casella R, Khoddami SM et al (2004) Urine detection of survivin is a sensitive marker for the noninvasive diagnosis of bladder cancer. J Urol 171:626–630

    Article  PubMed  CAS  Google Scholar 

  36. Horstmann M, Bontrup H, Hennenlotter J et al (2010) Clinical experience with survivin as a biomarker for urothelial bladder cancer. World J Urol 28:399–404

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Urologische Klinik und Poliklink, Ludwig-Maximilians-Universität München, LMU Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland

    S. Tritschler, F. Strittmatter, A. Karl & C. Stief

Authors
  1. S. Tritschler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Strittmatter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Karl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Stief
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Tritschler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tritschler, S., Strittmatter, F., Karl, A. et al. Urinmarkersysteme zur Diagnostik des Urothelkarzinoms. Urologe 52, 965–969 (2013). https://doi.org/10.1007/s00120-013-3227-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-013-3227-0

Schlüsselwörter

Keywords

Search

Navigation