Abstract Background The traditional approach to screening for urothelial cancer in patients employs urine cytology, but the detection of lesions in the upper urinary tract is suboptimal. In patients with suspected upper tract urothelial carcinoma (UTUC), the American Urological Association recommends instrumented sampling of urine for cytological examinations, but such invasive examinations are costly and potentially traumatic. This study reviews the possible role of ancillary tests on voided urine to diagnose upper tract urothelial carcinoma. Methods We executed a Pubmed search using the MESH terms Carcinoma, Transitional Cell, Biomarkers Tumor, DNA Methylation, Urine, Urologic Neoplasms, and Ureteral Neoplasms. Studies of ancillary tests (Epigenetic, sequencing, and immunoassay-based) on voided samples for the diagnosis of upper tract UC were included. We reviewed the performance data of the ancillary tests. Results We identified 11 qualifying upper tract-focused studies ranging from 22 to 402 urine samples. There were 7 tests reliant on evaluating DNA methylation, 1 test employing sequencing for mutation detection, and 3 immunoassay-based tests. Overall sensitivity ranged from 55.4 to 96% (mean = 82.3), and specificity from 68 to 100% (mean = 90.9). Conclusion Non-invasive detection of UTUC may be assisted by ancillary tests utilizing PCR, immunoassays, or epigenetic techniques. DNA methylation techniques show high sensitivity and appear to be frequently studied. The validation of the role of non-invasive ancillary tests in larger prospective studies is desirable due to the potential benefits from the minimization of upper tract instrumentation and lowered costs.
Olisaemeka Chukwudebe (Wed,) studied this question.