The occult urothelial cancer.
Transitional cell carcinoma (TCC) is the tumor that most frequently affects the urinary tract. The most common location is in the bladder; the diagnosis, as the follow-up, is based on urine cytology, endoscopic, and radiological examinations. Urinary cytology is an important non invasive tool used in the diagnosis and follow-up of patients with TCC. A positive urine cytology result is highly predictive of the presence of TCC, even in the presence of normal cystoscopy, because malignant cells may appear in the urine long time before any cystoscopically visible lesion becomes apparent. The presence of a positive urinary cytology, in the absence of clinical or endoscopic evidence of a TCC, can identify an occult urothelial cancer, located in any site of the urinary tract (upper urinary tract, bladder, prostatic urethra). Most of the urothelial tumors of the renal pelvis and ureters are diagnosed by radiological examinations, but we can observe a high rate of false negatives. In order to improve the diagnostic role of urinary cytology and other conventional examinations, numerous molecular markers have been identified; however, the real clinical application remains unclear. Photodynamic diagnosis and narrow band imaging (NBI) cystoscopy increase the diagnostic accuracy of endoscopic examinations in the presence of lesions not easily detectable. The aim of this review is to analyze the current diagnostic standards in the presence of occult urothelial cancer.
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Mauro
M
Ragonese
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Marco
M
Racioppi
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Daniele
D
D'Agostino
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Luca
L
Di Gianfrancesco
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Niccolò
N
Lenci
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Riccardo
R
Bientinesi
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Giuseppe
G
Palermo
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Emilio
E
Sacco
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Francesco
F
Pinto
Department of Urology, Catholic University of the Sacred Heart, Rome - Italy.
Pier Francesco
PF
Bassi
D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000652:urine; D006801:Humans; D014571:Urologic Neoplasms / Q000175:diagnosis* / Q000652:urine