Could nuclear matrix protein 22 (NMP22) play a role with urine cytology in screening for bladder cancer? - experience at Kuwait University

Uncovering the epidemiology of bladder cancer in the Arab world: A review of risk factors, molecular mechanisms, and clinical features

Objective

Bladder cancer (BC) is a significant public health concern in the Middle East and North Africa, but the epidemiology and clinicopathology of the disease and contributors to high mortality in this region remain poorly understood. The aim of this systematic review was to investigate the epidemiological features of BC in the Arab world and compare them to those in Western countries in order to improve the management of this disease.

Methods

An extensive electronic search of the PubMed/PMC and Cochrane Library databases was conducted to identify all articles published until May 2022, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A total of 95 articles were included in the final analysis after title, abstract, and full-text screening, with additional data obtained from the GLOBOCAN and WHO 2020 databases.

Results

Most of the included articles were case-control studies examining the risk factors and molecular mechanisms of BC. These studies originated from 10 different countries, with Egypt being the most active contributor. While BC in the Arab world shares some common risk factors with Western countries, such as smoking and occupational exposure, it also exhibits unique features related to schistosomiasis. The high mortality rates in this region are alarming and can be attributed to various factors, including the prevalence of smoking, the impact of schistosomiasis, a combination of genetic and socioeconomic factors, treatment shortages, and limited access to care or inadequate assessment of the quality of care.

Conclusion

Despite the relatively low incidence of BC in Arab countries, the mortality rates are among the highest worldwide. BC tends to be more aggressive in the Arab world, making it essential to implement strategies to address this burden.

Diagnostic performance of nuclear matrix protein 22 and urine cytology for bladder cancer: A meta-analysis

PURPOSE

To compare and analyze the diagnostic efficacy of nuclear matrix protein 22 (NMP22) and urine cytology (UC) in the diagnosis of bladder cancer.

METHODS

Search the Chinese and English studies on NMP22 and urinary cytology in the diagnosis of bladder tumors published between 1999 and June, and conduct quality evaluation, data extraction and analysis.

RESULTS

A total of 397 related articles were retrieved, and 12 articles were finally included after screening, including 2456 subjects. The heterogeneity test shows that there is no discernible threshold effect. Perform meta-analysis according to the random effects model. The results showed that the total sensitivity of NMP22 and UC were 0.79 (95% CI [0.73, 0.84]) (CI: Confidence interval), 0.55 (95% CI [0.41, 0.69]), and the total specificity 0.59 (95% CI [0.46], respectively, 0.71), 0.91 (95% CI (0.81, 0.96]), +LR 1.9 (95% CI [1.4, 2.6]) (+LR: positive likelihood ration), 5.9 (95% CI [3.3, 10.6]), -LR 0.35 (-LR: negative likelihood ration), respectively (95% CI [0.27, 0.47]), 0.49 (95% CI [0.38, 0.64]), diagnostic odds ratios 5 (95% CI [3, 9]), 12 (95% CI [7, 21]). The area under the summary receiver operating characteristics curve (AUC) was 0.79 (95% CI [0.75, 0.82]) and 0.81 (95% CI [0.77, 0.84]), respectively.

CONCLUSIONS

NMP22 has moderate diagnostic efficiency for bladder cancer. Its sensitivity is greater than UC, but its specificity is significantly lower than that of UC. At present, it cannot replace traditional cystoscopy and UC, but it can be combined to detect bladder tumors. It plays a major role in screening, postoperative monitoring and follow-up.

Urinary survivin mRNA expression and urinary nuclear matrix protein 22 BladderChek® and urine cytology in the detection of transitional cell carcinoma of the bladder

OBJECTIVE

To compare the diagnostic performance of urine cytology (UC), survivin mRNA expression, and the NMP22 BladderChek® (NMP22BC) test for the detection, grading and staging of transitional cell carcinoma (TCC) of the bladder.

MATERIALS AND METHODS

Voided urine samples collected from 25 healthy controls and 80 patients diagnosed with TCC of the bladder were subjected to UC, the NMP22BC test and reverse-transcription real-time PCR for survivin mRNA expression.

RESULTS

Survivin mRNA expression showed the highest sensitivity (87.5%) followed by the NMP22BC test (61.3%) while UC exhibited the lowest sensitivity (40%). All three urine markers had a similar specificity of 96% (95% CI 80.5-99.3%). Survivin mRNA expression was the only urine marker that showed a significant difference in relation to tumour histological grade (χ(2) 8.5, p = 0.015). None of the three urine markers was significantly related to tumour pathological stages.

CONCLUSION

The diagnostic sensitivity of urinary survivin mRNA expression was superior to that of UC and the NMP22BC test and correlates with tumour pathological grade but not stage.

The clinical usefulness of nuclear matrix protein-22 in patients with atypical urine cytology

Purpose

Difficulty exists in interpreting the significance of atypical urine cytology. This study was performed to assess the diagnostic utility of nuclear matrix protein-22 (NMP-22) testing when atypical cells are detected during urine cytology.

Materials and Methods

Among patients whose urine cytology was reported as atypical between January 2004 and December 2009, a total of 275 who also underwent NMP-22 testing were enrolled in the present study. These patients were further divided into the screening group (143 patients examined as outpatients for hematuria) and the follow-up group (132 patients followed up for previously diagnosed bladder cancer). The sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for atypical cytology alone and in conjunction with NMP-22.

Results

Of the 275 patients exhibiting atypical urine cytology, cancer was confirmed in 85, yielding a positive predictive value of 30.9% (85/275). Of the 96 patients testing positive for NMP-22, 58 were diagnosed with bladder cancer. The positive predictive value in conjunction with NMP-22 was 60.4% (58/96). The sensitivity, specificity, negative predictive value, and accuracy were 68.2% (58/85), 80.0% (152/190), 84.9% (152/179), and 76.2% (210/275), respectively. Testing for NMP-22 in the screening and follow-up groups increased the positive predictive value from 30.0% (43/143) to 64.0% (32/50) and from 31.3% (42/132) to 56.5% (26/46), respectively; there was no significant difference between the screening and follow-up groups (p=0.106).

Conclusions

When only cases with atypical urine cytology were examined, NMP-22 testing increased the detection rate of bladder cancer regardless of whether the test was used in screening hematuria or in following up patients.

[Diagnostic test for bladder cancer: the NMP22®]

INTRODUCTION

Diagnosis and follow-up of bladder cancer is based on cytology and cystoscopic exams. Cytology is highly specific but remains with a highly variable sensitivity. Cystoscopy is an invasive exam and has shown specific limits. Urinary test, highly specific and highly sensitive, might be ideal to replace the couple cytology-cystoscopy.

MATERIAL AND METHODS

Through a literature review, using MeSH system and Pubmed system (keywords: NMP22 and bladder cancer), authors pointed to the value of NMP22 to replace cystoscopy and cytology.

RESULTS

Between 1996 and 2010, 193 publications were identified with these keywords. Seventeen original articles have been selected based on their quality and methodology. NMP22 was more sensitive than cytology for follow-up and screening of bladder cancer. As screening test, NMP22 has shown positive predictive value between 0 and 70%. As follow-up test, NMP22 has shown more stable positive predictive value close to 70%. Coupled to cytology, NMP22 has shown predictive positive value up to 90%.

CONCLUSION

For screening test, NMP22 should be the referent test for best selection cases (tobacco, hematuria) and for systemic elimination of false positive cases (ureteral stent, lithiasis). For follow-up test, NMP22-cytology should be the new reference. Moreover, when NMP22 is positive with negative cystoscopy, follow-up may be carefully proposed (recurrence risk×10).

Performance of nuclear matrix protein 22 urine marker and voided urine cytology in the detection of urinary bladder tumors

BACKGROUND

Cystoscopy with urinary cytology is the gold standard for the diagnosis and follow-up of patients with tumors of the urinary bladder. The aim of the study was to evaluate the performance of the nuclear matrix protein 22 (NMP22) tumor marker test, BladderChek® point-of-care test and voided urinary cytology for the detection and follow-up of bladder tumors.

METHODS

NMP22 was measured using an ELISA assay in stabilized voided urine and using the BladderChek® test. Voided urinary cytology was performed on urine samples. Results were compared to cystoscopic findings and histopathological examination results after transurethral resection of the bladder lesion.

RESULTS

For the prediction of malignant histopathological result, sensitivity and specificity were 45.2% and 75.0%, respectively, for NMP22 at a cut-off of 7.5 kU/L, 17.7% and 100% for the BladderChek® test and 37.0% and 100% for voided urine cytology. For the prediction of suspicious or positive cystoscopic finding, sensitivity and specificity were 40.4% and 72.1%, respectively, for NMP22 at a cut-off of 7.5 kU/L, 14.8% and 93.8% for the BladderChek® test and 26.8% and 98.1% for voided urine cytology.

CONCLUSIONS

The NMP22 quantitative test showed higher sensitivity and lower specificity compared with voided urine cytology, whereas the sensitivity of the BladderChek® test was low. We could not recommend any of the three non-invasive tests as a replacement for cystoscopy for the diagnosis or follow-up of urinary bladder tumors.

Analysis of fluorescence in situ hybridization, mtDNA quantification, and mtDNA sequence for the detection of early bladder cancer

We designed this study to test the sensitivities of cytology, the nuclear matrix protein 22 (NMP22) assay, and fluorescence in situ hybridization (FISH) in the early detection of urothelial carcinoma, and to identify mtDNA alterations in urinary epithelial cells. We collected 41 urine samples and 26 corresponding peripheral blood samples from patients with clinically suspected urothelial carcinoma. The FISH and NMP22 assays detected 92.1% of the cancers, and cytology detected 60.5%. In the low-grade group, NMP22 and FISH analyses were more sensitive than cytology, but in the high-grade group, all three methods showed approximately 90% sensitivity. Overall, the FISH and NMP22, or FISH and cytology assays combined detected 97.4% of cancers, while cytology with NMP22 detected 92.1%. In the low-grade group, the sensitivity of the three methods combined was above 80%, but in high-grade group, the combined sensitivity was approximately 100%. In the mtDNA control region, we detected characteristic heteroplasmic mtDNA substitution mutations in 1 patient and a mtDNA length heteroplasmic mutation in 303 polyC or 16184 poly C in 20 patients. Overall, urothelial carcinoma-specific mtDNA mutations were observed in 20 of the 26 patients (76.9%). The average mtDNA copy numbers in urine samples and corresponding peripheral blood samples (83.45 +/- 60.36 and 39.0 +/- 24.38, respectively) (mean +/- standard deviation [SD]) differed significantly (P < 0.001). The mtDNA copy numbers in the urine samples from patients with high-grade and low-grade tumors (81.83 +/- 67.78 and 86.49 +/- 46.69, respectively) did not differ significantly (P = 0.589). In conclusion, the FISH assay showed the highest sensitivity for detecting low-grade urothelial carcinoma, and mtDNA copy numbers in urine samples were higher than those in the corresponding peripheral blood samples. The frequency of mtDNA mutations in the D-loop region in patients with cancer was approximately 80% in our study. This report further supports the significance of genetic alteration in urothelial carcinoma and the clinical utility of the FISH, mtDNA quantitation polymerase chain reaction, mtDNA sequencing, and capillary electrophoresis for this purpose.