Department of Pathology, Keck School of Medicine, University of Southern California, Health Sciences Campus, 2011 Zonal Avenue, HMR 308, Los Angeles, CA 90033, USA.
Nat Rev Urol. 2010 Jan;7(1):11-20. doi: 10.1038/nrurol.2009.236.
Carcinoma of the urinary bladder is a common malignancy and a major cause of morbidity and mortality in the western world. Current understanding of etiology, disease process, molecular characteristics and management principles make urothelial carcinoma an ideal candidate for screening. The capacity of traditional noninvasive diagnostic procedures such as microhematuria testing and urine cytology to be used as stand-alone screening techniques is limited, however. New qualitative and quantitative molecular screening modalities can detect cellular and subcellular alterations that are often exclusively associated with urothelial carcinoma. Such alterations can be detected in a noninvasive manner, using urine as a marker source, with reasonable sensitivity and specificity. Application of several molecular assays in conjunction with traditional screening methods has had promising results. We propose an evidence-based and risk-based approach to future bladder cancer screening. Such an approach would harness the reasonable sensitivity, ease of use and cost-effectiveness of microhematuria testing, plus the specificity of molecular tests, to target high-risk populations for screening. The ultimate goals are to identify susceptible individuals, detect bladder tumors before they invade using unobtrusive and cost-effective methods, and optimize surveillance strategies for long-term follow-up.
膀胱癌是一种常见的恶性肿瘤，也是西方国家发病率和死亡率的主要原因。目前对病因、疾病过程、分子特征和治疗原则的了解，使得尿路上皮癌成为筛查的理想选择。然而，传统的非侵入性诊断方法，如微量血尿检测和尿液细胞学检查，作为独立的筛查技术，其能力有限。新的定性和定量分子筛查方法可以检测到通常仅与尿路上皮癌相关的细胞和亚细胞改变。这些改变可以通过使用尿液作为标记物来源的非侵入性方式，以合理的灵敏度和特异性来检测。几种分子检测方法的应用与传统的筛查方法相结合，取得了有希望的结果。我们提出了一种基于证据和风险的未来膀胱癌筛查方法。这种方法将利用微量血尿检测的合理灵敏度、易用性和成本效益，加上分子检测的特异性，针对高危人群进行筛查。最终目标是识别易患个体，使用非侵入性和具有成本效益的方法在肿瘤侵犯之前检测膀胱癌，并优化长期随访的监测策略。
