Diagnostic Performance of Urinary Biomarker Tests in Detecting Bladder Cancer: A Systematic Review, Meta-analysis, and Network Meta-analysis.

OBJECTIVE

To assess the diagnostic estimates of current urine-based diagnostic bladder tests for diagnosing bladder cancer using diagnostic test accuracy (DTA) and network meta-analysis (NMA).

METHODS

The search for this systematic review and meta-analysis was conducted on PubMed and Medline for relevant studies published until September 30, 2025. The meta-analysis and network meta-analysis were performed using a random-effect model, to compute the pooled sensitivity and specificity of the markers. The qualitative synthesis included 122 studies comprising 24,252 patients.

RESULTS

In most studies, there was an unclear risk of bias in the setting of evaluating de novo and recurrent bladder cancer. Novel urine-based assays demonstrated promising diagnostic values with pooled sensitivity upto 90% and specificity upto 92%. The NMA revealed that diagnostic values of the novel urine-based assays were significantly higher than those of cytology for detecting bladder cancer.

CONCLUSION

Over the past decade, several new urine-based bladder cancer detection assays have become commercially available. Our analysis supports a high diagnostic accuracy of the newer urine-based bladder cancer detection tests for evaluating bladder cancer.

PROSPERO REGISTRATION: CRD420251134193.