Liquid biopsy guides kidney-sparing decisions in upper tract urothelial carcinoma without replacing standard care

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Frontiers in Medicine Published June 3, 2026 Medically reviewed June 3, 2026 Study authors: Difei Yu, Jiarun Tang, Yu Zhang, Ke Hu, Jing Qing, Jiamo Zhang DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider liquid biopsy as an adjunct to, not a replacement for, standard imaging and pathology in upper tract urothelial carcinoma.

This review addresses the role of liquid biopsy-guided kidney-sparing management in patients with upper tract urothelial carcinoma. The scope focuses on integrating this tool into existing diagnostic workflows rather than establishing it as a standalone diagnostic method. The authors synthesize the current understanding of how liquid biopsy can inform clinical decisions while maintaining reliance on established standards.

The central argument is that liquid biopsy should function as an adjunctive, decision-enhancing layer rather than a replacement for imaging, ureteroscopy, pathology, or multidisciplinary judgment. This perspective emphasizes the importance of preserving standard diagnostic pathways while potentially leveraging molecular data to refine management strategies for kidney preservation.

The review highlights several limitations inherent to the current evidence base. Specifically, the authors note that data on primary outcomes, secondary outcomes, safety, and tolerability were not reported. Consequently, the practice relevance is framed cautiously, suggesting that clinicians should continue to prioritize comprehensive evaluation including imaging and pathology alongside liquid biopsy results.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Upper tract urothelial carcinoma (UTUC) presents a clinically important gap in urologic oncology: treatment intensity is determined before surgery, yet conventional preoperative risk stratification remains imperfect. Kidney-sparing surgery (KSS) is established for selected low-risk disease and is increasingly considered when renal preservation is clinically important, but safe selection depends on distinguishing technically manageable tumors from biologically unsuitable disease. Computed tomography urography (CTU), cytology, ureteroscopy, and ureteroscopic biopsy remain indispensable, although they describe anatomy and morphology more reliably than tumor biology. Urine-based liquid biopsy platforms, including DNA methylation, mutational, multiplex RNA, copy-number, and protein assays, appear most mature for noninvasive detection and preoperative triage. Plasma circulating tumor DNA (ctDNA), in contrast, appears more closely linked to biological upstaging, occult muscle-invasive or non-organ-confined disease, perioperative risk refinement, and molecular residual disease surveillance. This review follows the KSS decision chain from patient selection to postoperative monitoring. We emphasize that current evidence supports liquid biopsy as an adjunctive, decision-enhancing layer rather than a replacement for imaging, ureteroscopy, pathology, or multidisciplinary judgment. Future studies should move beyond isolated sensitivity and specificity estimates and test whether biomarker-informed pathways improve treatment allocation, renal preservation, surveillance burden, and oncologic outcomes.