New diagnostic strategies in the detection and staging of bladder cancer.

PURPOSE OF REVIEW: Bladder cancer is a very frequent disease and represents the second most common genitourinary neoplasm. The most prevalent form of the disease, superficial bladder cancer, can recur in more than 70% of cases, despite correct management. Any way to improve our disease diagnostic and treatment policy is therefore welcome. RECENT
FINDINGS: This review covers the following topics: (1). endoscopic tools: standard cystoscopy versus fluorescence cystoscopy and virtual endoscopy; (2). bladder cancer staging: histopathological analysis developments and imaging techniques (positron emission tomography, magnetic resonance imaging, computed tomography); (3). cytology and ancillary procedures (ImmunoCyt and fluorescence in-situ hybridization test, and others); (4). first-generation (bladder tumour antigen, nuclear matrix protein 22, telomerase repeat amplification protocol) and second-generation (loss of heterozygosity, minichromosome maintenance 5, DNA methylation, microsatellite) urine and serum markers.
SUMMARY: New diagnostic and therapeutic (endoscopic) tools in superficial bladder cancer should eventually modify our disease management policy. Fluorescence cystoscopy detects carcinoma in situ with a high accuracy, and seems to have a positive impact on reducing residual tumour and recurrence rate. A more specific staining of tissue specimens facilitates histological analysis and helps achieve better staging, especially in T1 diseases. Improving the sensitivity of cytology for low-grade diseases, ancillary procedures to classic cytology such as fluorescence in-situ hybridization and ImmunoCyt tests, may reduce the number of unpleasant cystoscopies in surveillance protocols of selected groups of patients. Second-generation urine markers such as loss of heterozygosity, microsatellite, minichromosome maintenance 5, with a high level of accuracy, show great potential for influencing bladder cancer detection and screening policy.