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Cheng K, Wan S, Chen SY, Yang JW, Wang HL, Xu CH, Qiao SH, Yang L. Nuclear matrix protein 22 in bladder cancer. Clin Chim Acta 2024; 560:119718. [PMID: 38718852 DOI: 10.1016/j.cca.2024.119718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/19/2024]
Abstract
Bladder cancer (BC) is ranked as the ninth most common malignancy worldwide, with approximately 570,000 new cases reported annually and over 200,000 deaths. Cystoscopy remains the gold standard for the diagnosis of BC, however, its invasiveness, cost, and discomfort have driven the demand for the development of non-invasive, cost-effective alternatives. Nuclear matrix protein 22 (NMP22) is a promising non-invasive diagnostic tool, having received FDA approval. Traditional methods for detecting NMP22 require a laboratory environment equipped with specialized equipment and trained personnel, thus, the development of NMP22 detection devices holds substantial potential for application. In this review, we evaluate the NMP22 sensors developed over the past decade, including electrochemical, colorimetric, and fluorescence biosensors. These sensors have enhanced detection sensitivity and overcome the limitations of existing diagnostic methods. However, many emerging devices exhibit deficiencies that limit their potential clinical use, therefore, we propose how sensor design can be optimized to enhance the likelihood of clinical translation and discuss the future applications of NMP22 as a legacy biomarker, providing insights for the design of new sensors.
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Affiliation(s)
- Kun Cheng
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730000, PR China; Gansu Province Clinical Research Center for Urology, Lanzhou 730000, PR China
| | - Shun Wan
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730000, PR China; Gansu Province Clinical Research Center for Urology, Lanzhou 730000, PR China
| | - Si-Yu Chen
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730000, PR China; Gansu Province Clinical Research Center for Urology, Lanzhou 730000, PR China
| | - Jian-Wei Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730000, PR China; Gansu Province Clinical Research Center for Urology, Lanzhou 730000, PR China
| | - Hai-Long Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730000, PR China; Gansu Province Clinical Research Center for Urology, Lanzhou 730000, PR China
| | - Chang-Hong Xu
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730000, PR China; Gansu Province Clinical Research Center for Urology, Lanzhou 730000, PR China
| | - Si-Hang Qiao
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730000, PR China; Gansu Province Clinical Research Center for Urology, Lanzhou 730000, PR China
| | - Li Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730000, PR China; Gansu Province Clinical Research Center for Urology, Lanzhou 730000, PR China.
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Zhang J, Xu R, Lu Q, Xu Z, Liu J, Li P, Zhang Y, Zhou C, Luo L, Tang W, Wang Z, Cao M, Cao J, Xu G, Wang L. A Novel Methylation Marker NRN1 plus TERT and FGFR3 Mutation Using Urine Sediment Enables the Detection of Urothelial Bladder Carcinoma. Cancers (Basel) 2023; 15:cancers15030615. [PMID: 36765573 PMCID: PMC9913436 DOI: 10.3390/cancers15030615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Aberrant DNA methylation is an early event during tumorigenesis. In the present study, we aimed to construct a methylation diagnostic tool using urine sediment for the detection of urothelial bladder carcinoma, and improved the diagnostic performance of the model by incorporating single-nucleotide polymorphism (SNP) sites. METHODS A three-stage analysis was carried out to construct the model and evaluate the diagnostic performance. In stage I, two small cohorts from Xiangya hospital were recruited to validate and identify the detailed regions of collected methylation biomarkers. In stage II, proof-of-concept study cohorts from the Hunan multicenter were recruited to construct a diagnostic tool. In stage III, a blinded cohort comprising suspicious UBC patients was recruited from Beijing single center to further test the robustness of the model. RESULTS In stage I, single NRN1 exhibited the highest AUC compared with six other biomarkers and the Random Forest model. At the best cutoff value of 5.16, a single NRN1 biomarker gave a diagnosis with a sensitivity of 0.93 and a specificity of 0.97. In stage II, the Random Forest algorithm was applied to construct a diagnostic tool, consisting of NRN1, TERT C228T and FGFR3 p.S249C. The tool exhibited AUC values of 0.953, 0.946 and 0.951 in training, test and all cohorts. At the best cutoff value, the model resulted in a sensitivity of 0.871 and a specificity of 0.947. In stage III, the diagnostic tool achieved a good discrimination in the external validation cohort, with an overall AUC of 0.935, sensitivity of 0.864 and specificity of 0.895. Additionally, the model exhibited a superior sensitivity and comparable specificity compared with conventional cytology and FISH. CONCLUSIONS The diagnostic tool exhibited a highly specific and robust performance. It may be used as a replaceable approach for the detection of UBC.
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Affiliation(s)
- Junjie Zhang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha 410028, China
| | - Qiang Lu
- Department of Urology, Hunan Provincial People’s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha 410002, China
| | - Zhenzhou Xu
- Department of Urology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medical, Central South University, Changsha 410013, China
| | - Jianye Liu
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Pei Li
- Hunan Yearth Biotechnology Co., Ltd., Changsha 410205, China
| | - Yaqun Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100006, China
| | - Chuanchi Zhou
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Lufeng Luo
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Wei Tang
- Hunan Yearth Biotechnology Co., Ltd., Changsha 410205, China
| | - Zhenting Wang
- Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Changsha 410017, China
| | - Manman Cao
- Hunan Yearth Biotechnology Co., Ltd., Changsha 410205, China
| | - Jian Cao
- Department of Urology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medical, Central South University, Changsha 410013, China
| | - Genming Xu
- Hunan Yearth Biotechnology Co., Ltd., Changsha 410205, China
- Correspondence: (G.X.); (L.W.)
| | - Long Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
- Correspondence: (G.X.); (L.W.)
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3
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Piao XM, Jeong P, Kim YH, Byun YJ, Xu Y, Kang HW, Ha YS, Kim WT, Lee JY, Woo SH, Kwon TG, Kim IY, Moon SK, Choi YH, Cha EJ, Yun SJ, Kim WJ. Urinary cell-free microRNA biomarker could discriminate bladder cancer from benign hematuria. Int J Cancer 2018; 144:380-388. [PMID: 30183088 DOI: 10.1002/ijc.31849] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/06/2018] [Accepted: 08/27/2018] [Indexed: 12/24/2022]
Abstract
The most common symptom of bladder cancer (BC) is hematuria. However, not all patients with hematuria are diagnosed with BC. Here, we explored a novel method to discriminate BC from hematuria under nonmalignant conditions by measuring differences in urinary cell-free microRNA (miRNA) expression between patients with BC and those with hematuria. A multicenter study was performed using 543 urine samples obtained from the National Biobank of Korea, including 326 BC, 174 hematuria and 43 pyuria without cancer. The urinary miR-6124 to miR-4511 ratio was considerably higher in BC than in hematuria or pyuria, and enabled the discrimination of BC from patients with hematuria at a sensitivity of >90% (p < 0.001). Conclusively, the proposed noninvasive diagnostic tool based on the expression ratio of urinary cell-free miR-6124 to miR-4511 can reduce unnecessary cystoscopies in patients with hematuria undergoing evaluation for BC, with a minimal loss in sensitivity for detecting cancer.
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Affiliation(s)
- Xuan-Mei Piao
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Pildu Jeong
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Ye-Hwan Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Young Joon Byun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Yanjie Xu
- Department of Surgery, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Ho Won Kang
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Urology, Kyungpook National University Hospital, Daegu, South Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jong-Young Lee
- Department of Business Data Convergence, Chungbuk National University, Cheongju, South Korea.,Theragen Etex Bio Institute, Suwon, 443-270, South Korea
| | - Seung Hwo Woo
- Department of Urology, Eulji University Hospital, Daejeon, South Korea
| | - Tae Gyun Kwon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Urology, Kyungpook National University Hospital, Daegu, South Korea
| | - Isaac Y Kim
- Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, The Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sung-Kwon Moon
- Department of Food Science and Technology, Chung-Ang University, Ansung, 456-756, South Korea
| | - Yung Hyun Choi
- Department of Biochemistry, College of Oriental Medicine, Dong-Eui University, Busan, South Korea
| | - Eun-Jong Cha
- Department of Biomedical Engineering, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Seok Joong Yun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
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D’Costa JJ, Goldsmith JC, Wilson JS, Bryan RT, Ward DG. A Systematic Review of the Diagnostic and Prognostic Value of Urinary Protein Biomarkers in Urothelial Bladder Cancer. Bladder Cancer 2016; 2:301-317. [PMID: 27500198 PMCID: PMC4969711 DOI: 10.3233/blc-160054] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For over 80 years, cystoscopy has remained the gold-standard for detecting tumours of the urinary bladder. Since bladder tumours have a tendency to recur and progress, many patients are subjected to repeated cystoscopies during long-term surveillance, with the procedure being both unpleasant for the patient and expensive for healthcare providers. The identification and validation of bladder tumour specific molecular markers in urine could enable tumour detection and reduce reliance on cystoscopy, and numerous classes of biomarkers have been studied. Proteins represent the most intensively studied class of biomolecule in this setting. As an aid to researchers searching for better urinary biomarkers, we report a comprehensive systematic review of the literature and a searchable database of proteins that have been investigated to date. Our objective was to classify these proteins as: 1) those with robustly characterised sensitivity and specificity for bladder cancer detection; 2) those that show potential but further investigation is required; 3) those unlikely to warrant further investigation; and 4) those investigated as prognostic markers. This work should help to prioritise certain biomarkers for rigorous validation, whilst preventing wasted effort on proteins that have shown no association whatsoever with the disease, or only modest biomarker performance despite large-scale efforts at validation.
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Affiliation(s)
- Jamie J. D’Costa
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James C. Goldsmith
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jayne S. Wilson
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard T. Bryan
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Douglas G. Ward
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Doğan C, Pelit ES, Yıldırım A, Zemheri IE, Çanakcı C, Başok EK, Çaşkurlu T. The value of the NMP22 test for superficial bladder cancer diagnosis and follow-up. Turk J Urol 2015; 39:137-42. [PMID: 26328097 DOI: 10.5152/tud.2013.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/25/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we investigated the efficacy of nuclear matrix protein 22 (NMP22) in the diagnosis and surveillance of bladder cancer. MATERIAL AND METHODS Patients with hematuria or who applied for cystoscopic control of proven bladder cancer were prospectively enrolled in this study. Routine cytologic examination and NMP22 test were performed on the voided urine sample obtained before the cystoscopy. The patients who had been diagnosed with bladder cancer were categorized according to stage, grade, number, size of the tumor and risk of the disease. Then the diagnostic performance of the NMP22 and the cytology test, alone or in combination, were evaluated separately using ROC curves in the diagnosis and surveillance groups. RESULTS A total of 87 patients (87/136) were investigated because of hematuria. The sensitivity, specificity, positive and, negative predictive values, and positive likelihood ratio (LR+) of the NMP22 test were 70, 80, 68, 81, and 3.42%, respectively. While, the sensitivity, specificity, positive and, negative predictive values, and positive likelihood ratio (LR+) of the cytology examination were 27, 96, 82, 68, and 7.36%, respectively. There were 49 patients in the bladder cancer group. The sensitivity, specificity, positive, and negative predictive values and positive likelihood ratio (LR+) of the NMP22 test in these patients were 33, 76, 31, 78 and 1.37%, respectively. The sensitivity, specificity, positive and, negative predictive values, and positive likelihood ratio (LR+) of the cytology examination were 25%, 97%, 75%, 80% and 9.25, respectively. CONCLUSION NMP22 test can be used as an adjunctive tool for the detection of bladder cancer, but its diagnostic performance is limited in surveillance when used alone or in combination with a cytology examination.
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Affiliation(s)
- Caner Doğan
- Department of Urology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Eyyüp Sabri Pelit
- Department of Urology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Asıf Yıldırım
- Department of Urology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Itır Ebru Zemheri
- Department of Pathology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Cengiz Çanakcı
- Department of Urology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Erem Kaan Başok
- Department of Urology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Turhan Çaşkurlu
- Department of Urology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
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Abstract
Bladder cancer (BC) represents the fourth most common neoplasia in men and the ninth most common cancer in women, with a significant morbidity and mortality. Cystoscopy and voided urine cytology (involving the examination of cells in voided urine to detect the presence of cancerous cells) are currently the routine initial investigations in patients with hematuria or other symptoms suggestive of BC. Around 75-85% of the patients are diagnosed as having non-muscle-invasive bladder cancer (NMIBC). Despite the treatment, these patients have a probability of recurrence at 5 years ranging from 50 to 70% and of progression to muscle invasive disease of 10-15%. Patients with NMIBC must undergo life-long surveillance, consisting of serial cystoscopies, possibly urine cytology and ultrasonography. Cystoscopy is unsuitable for screening because of its invasiveness and costs; serial cystoscopies may cause discomfort and distress to patients. Furthermore, cystoscopy may be inconclusive, falsely positive or negative. Although urine cytology has a reasonable sensitivity for the detection of high-grade BC, it lacks sensitivity to detect low-grade tumors (sensitivity ranging from 4 to 31%). The overall sensitivity and specificity of urine cytology range from 7 to 100 and from 30 to 70%, respectively. There is a need for new urine biomarkers that may help in BC diagnosis and surveillance. A lot of urinary biomarkers with high sensitivity and/or specificity have been investigated. Although none of these markers have proven to be powerful enough to replace standard cystoscopy, some of them may represent accurate predictors of BC. A review of recent studies is presented.
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Abstract
Bladder cancer has the fifth highest incidence of all malignancies in the United States, with a propensity to recur, requiring lifelong surveillance after diagnosis. Urinary markers of disease have been of extreme interest in this field in an effort to simplify surveillance schedules and improve early detection of tumors. Many markers have been described, but most remain investigational. However, some markers have undergone clinical trials and are approved for clinical use. In this review, urinary markers and their application for screening and surveillance of bladder cancer are discussed.
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Huber S, Schwentner C, Taeger D, Pesch B, Nasterlack M, Leng G, Mayer T, Gawrych K, Bonberg N, Pelster M, Johnen G, Bontrup H, Wellhäusser H, Bierfreund HG, Wiens C, Bayer C, Eberle F, Scheuermann B, Kluckert M, Feil G, Brüning T, Stenzl A. Nuclear matrix protein-22: a prospective evaluation in a population at risk for bladder cancer. Results from the UroScreen study. BJU Int 2012; 110:699-708. [PMID: 22313585 DOI: 10.1111/j.1464-410x.2011.10883.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? The prognosis of bladder cancer significantly depends on tumour stage and time of diagnosis so early diagnosis is desirable to decrease mortality and treatment costs. The NMP22 test is approved for clinical application by the Food and Drug Administration (FDA) of the US. Previous studies have reported values of 47-100% for sensitivity and 58-91% for specificity with this test, but there is no new data on the predictive value of NMP22 for screening bladder cancer (BC). The most important risk factor for BC is the tobacco consumption but occupational exposure to carcinogenic substances, especially aromatic amines, is regarded as another risk factor. The UroScreen study is a prospective longitudinal study for the early detection of BC. To our knowledge, it is the largest prospective validation study conducted over the longest period of time. The study results led us to conclude that, based on the currently available data, NMP22 should not be regarded as an alternative to endoscopy, and we could not make a general recommendation for screening or follow-up. The UroScreen results indicate that urine-based molecular markers could be a suitable addition to urine cytology and the detection of microhaematuria. OBJECTIVE To evaluate the value of nuclear matrix protein-22 (NMP22) in bladder cancer (BC) screening, and its effect on variables in a prospective study in a high-risk population. PATIENTS AND METHODS A total of 1772 chemical workers (mean age 62 years) exposed to carcinogenic aromatic amines were enrolled in the study. In all, 7091 screening check-ups in 1609 subjects were performed. Urine samples were collected for a quantitative NMP22 immunoassay, urine analysis and creatinine concentration assessment. Cystoscopy and subsequent transurethral resection were performed where there were suspicious findings. RESULTS Histopathological analysis found three papillary urothelial neoplasms of low malignant potential, five recurrent BCs and 13 primary BCs. Three tumours were at a muscle-invasive stage (pT2, pT3a or pT3b). We found higher NMP22 concentrations (>10 U/mL) in 224 patients, which correctly predicted BC in six cases (sensitivity 97.29%, specificity 28.57%; negative predictive value 99.04%, positive predictive value 12.24%). Gross haematuria affected NMP22 results (odd ratio [OR] 3.49, 95% confidence interval [CI] 1.81-6.73). Infection also affected NMP22 results (OR 4.13, 95% CI 2.31-7.35). NMP22 was more frequently positive in urine with creatinine concentration >2.5 g/L (OR 1.61, 95% CI 0.91-2.86). CONCLUSIONS NMP22 outcomes are affected by haematuria, infection and concentrated urine. NMP22 alone cannot be recommended for primary screening in a high-risk population nor as an alternative to cystoscopy during follow-up. A NMP22 test might be a useful adjunct to urine cytology.
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Affiliation(s)
- Severine Huber
- Department of Urology, Eberhard Karls University, Tübingen, Germany
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Ahmed HG, Tom MAM. The consequence of delayed fixation on subsequent preservation of urine cells. Oman Med J 2011; 26:14-8. [PMID: 22043372 PMCID: PMC3191613 DOI: 10.5001/omj.2011.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 09/07/2010] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Degenerative changes caused by delays in urine preservation contribute to false-negative and false-positive interpretation of urothelial disease in cytology. The aim of this study is to assess whether the delay of fixation of urine samples makes any significant difference to urine cytology and morphology, and the limit of acceptability of delay for routine use in the hospital laboratory. METHODS Three cell collection fluids were evaluated by analyzing the preservation and degeneration of cells in urine samples. In this study, 50 voided urine specimens were taken at random from females complaining of vaginal discharge. Each specimen was divided into three sterile containers. The first was immediately centrifugated and the deposit was smeared onto a cleaned micro slide and immediately fixed into 95% ethyl alcohol for 15 minutes. The remaining two were prepared in the same manner, however, the second after two hours of collection and the third after four hours of collection. The degree of degeneration and thus the preservation were assessed by a table of chosen criteria, then ranked and analyzed using Friedman's nonparametric test, at p=0.05. RESULTS The results showed a significant difference between the preservation and the delay in urine fixation, p<0.0001. CONCLUSION Any delay in fixation of urine specimen for cytology affects the preservation of cells, which may result in miss diagnosis. It is recommended that urine samples for cytology should be fixed immediately after collection.
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Affiliation(s)
- Hussain G. Ahmed
- Department of Histopathology and Cytology, Faculty of Medical laboratory Sciences, University of Khartoum, Sudan; Sudanese Cancer Foundation
| | - Murtada AM Tom
- Department of Histopathology and Cytology, Faculty of Medical laboratory Sciences, Sudan University of Science and Technology, Khartoum, Sudan
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Shariat SF, Karam JA, Raman JD. Urine cytology and urine-based markers for bladder urothelial carcinoma detection and monitoring: developments and future prospects. Biomark Med 2008; 2:165-80. [DOI: 10.2217/17520363.2.2.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Bladder cancer is currently diagnosed using cystoscopy and cytology in patients with suspicious signs and symptoms. These tests are also used to monitor patients with a history of bladder cancer. The recurrence rate for bladder cancer is high, thus necessitating long-term follow-up. Urine cytology has a high sensitivity and specificity for the detection of high-grade urothelial carcinoma, but lacks the sensitivity to detect low-grade tumors. Recently, multiple noninvasive urine-based bladder cancer tests have been developed. Many markers (BTA stat®, BTA TRAK®, ImmunoCyt™, NMP22® and UroVysion™) have already been approved by the US FDA for bladder cancer surveillance, while other markers are still undergoing development, preclinical and clinical investigation. An ideal bladder cancer test would be noninvasive, highly sensitive and specific, inexpensive, easy to perform and yield highly reproducible results. Many of the tests reviewed herein meet some, but not all, of these criteria.
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Affiliation(s)
- Shahrokh F Shariat
- The University of Texas Southwestern Medical Center, Department of Urology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA
| | - Jose A Karam
- The University of Texas Southwestern Medical Center, Department of Urology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA
| | - Jay D Raman
- The University of Texas Southwestern Medical Center, Department of Urology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA
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Raistrick J, Shambayati B, Dunsmuir W. Collection fluid helps preservation in voided urine cytology. Cytopathology 2007; 19:111-7. [DOI: 10.1111/j.1365-2303.2006.00396.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Schwaibold HE, Sivalingam S, May F, Hartung R. The value of a second transurethral resection for T1 bladder cancer. BJU Int 2006; 97:1199-201. [PMID: 16566814 DOI: 10.1111/j.1464-410x.2006.06144.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate a series of repeat transurethral resections (TURs) of tumour in patients with T1 bladder cancer, usually used to ensure a complete resection and to exclude the possibility muscle-invasive disease. PATIENTS AND METHODS In all, 136 consecutive patients had a second TUR because of a histopathological diagnosis of T1 transitional cell carcinoma (TCC) after their initial TUR. Of the 136 patients, 101 were first presentations and 35 had recurrent tumours. The second TUR was done 4-6 weeks later. The evaluation included the presence of previously undetected residual tumour, changes to histopathological staging/grading, and tumour location. RESULTS In all, 71 patients (52%) had residual disease according to findings from specimens obtained during the second TUR. The staging was: no tumour, 65 (48%); Ta, 11 (8%); T1, 32 (24%); Tis, 15 (11%); and > or = T2, 13 (10%). Histopathological changes that worsened the prognosis (>T1 and or concomitant Tis) were found in 21% of patients. Residual malignant tissue was found in the same location as the first TUR in 86% of the patients, and at different locations in 14%. Overall, 28 patients (21% of the original 136) had a radical cystectomy as a consequence of the second TUR findings. CONCLUSIONS A routine second TUR should be advised in patients with T1 TCC of the bladder, to achieve a more complete tumour resection and to identify patients who should have a prompt cystectomy.
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Lokeshwar VB, Habuchi T, Grossman HB, Murphy WM, Hautmann SH, Hemstreet GP, Bono AV, Getzenberg RH, Goebell P, Schmitz-Dräger BJ, Schalken JA, Fradet Y, Marberger M, Messing E, Droller MJ. Bladder tumor markers beyond cytology: International Consensus Panel on bladder tumor markers. Urology 2006; 66:35-63. [PMID: 16399415 DOI: 10.1016/j.urology.2005.08.064] [Citation(s) in RCA: 295] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 08/08/2005] [Indexed: 12/27/2022]
Abstract
This is the first of 2 articles that summarize the findings of the International Consensus Panel on cytology and bladder tumor markers. The objectives of our panel were to reach a consensus on the areas where markers are needed, to define the attributes of an ideal tumor marker, and to identify which marker(s) would be suitable for diagnosis and/or surveillance of bladder cancer. Our panel consisted of urologists and researchers from Europe, Asia, and the United States who reviewed original articles, reviews, and book chapters on individual bladder tumor markers published in the English language mainly using the PubMed search engine. Panel members also met during 3 international meetings to write recommendations regarding bladder tumor markers. The panel found that the most practical use of noninvasive tests is to monitor bladder cancer recurrence, thereby reducing the number of surveillance cystoscopies performed each year. Markers also may be useful in the screening of high-risk individuals for early detection of bladder cancer. However, more prospective studies are needed to strengthen this argument. Case-control and cohort studies show that several markers have a higher sensitivity to detect bladder cancer. However, cytology is the superior marker in terms of specificity, although some markers in limited numbers of studies have shown specificity equivalent to that of cytology. Our panel believes that several bladder tumor markers are more accurate in detecting bladder cancer than prostate-specific antigen (PSA) is in detecting prostate cancer. However, bladder tumor markers are held to a higher standard than PSA. Therefore, use of bladder tumor markers in the management of patients with bladder cancer will require the willingness of both urologists and clinicians to accept them.
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Allen DJ, Challacombe B, Clovis JS, Chandra A, Dasgupta P, Popert R. Urine cytology: appropriate usage maximizes sensitivity and reduces cost. Cytopathology 2005; 16:139-42. [PMID: 15924609 DOI: 10.1111/j.1365-2303.2005.00255.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Urine cytology is costly because of the skilled manpower required for analysis. Inappropriate requests are a significant drain both financially and on the cytopathologist's time. The present study aimed at identifying the extent and cause of this misuse and reduce it. METHODS An audit of urine cytology usage was undertaken using the hospital results reporting system to identify requests. Patient case notes were then obtained to gain further clinical information. Initially a 2-week period was analysed, following which departmental guidelines for requesting urine cytology were produced and circulated. The audit loop was then closed. RESULTS Over the initial 2-week period, 117 urine cytology requests were received. Thirty-three per cent were inappropriate, either because they were from patients with benign disease or because of duplication. Following the education programme this number fell to 6%. Expenditure on unnecessary samples thus decreased from pounds 2418 to only pounds 310, giving an annual overall saving of pounds 55,000. CONCLUSION Significant cost and time savings can be made if urine cytology is sent appropriately. Simple guidelines and staff education are the key to reducing inefficiency. Our findings have implications not just for cytopathology costs but for laboratory and radiology requests in general.
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Affiliation(s)
- D J Allen
- Department of Urology, Guy's and St Thomas' NHS Trust, London, UK.
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15
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Cheng ZZ, Corey MJ, Pärepalo M, Majno S, Hellwage J, Zipfel PF, Kinders RJ, Raitanen M, Meri S, Jokiranta TS. Complement Factor H as a Marker for Detection of Bladder Cancer. Clin Chem 2005; 51:856-63. [PMID: 15774575 DOI: 10.1373/clinchem.2004.042192] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AbstractBackground: The BTA TRAK™ and BTA stat™ tests for bladder cancer use monoclonal antibodies (mAbs) X13.2 and X52.1 to detect factor H (FH)-related material in urine. The exact ligands remain unknown.Methods: Western blot analyses of purified FH, recombinant factor H-related protein 1 (FHR-1), and serum and urine samples were used to identify the ligands of X13.2 and X52.1. Recombinant FH constructs were used to identify the target sites of X13.2 and X52.1. To analyze whether natural ligands of FH could compete with its recognition by the capture mAb X52.1, we used surface plasmon resonance analysis. The role of the ligands of X52.1 in the BTA TRAK assay was tested with use of purified proteins and FH-depleted samples.Results: X13.2 bound to domain 3 of FH and FH-like protein 1, whereas X52.1 bound to domain 18 of FH and to FHR-1. Using specific FH depletion from a bladder cancer patient’s urine and purified FH, we demonstrated that FH is the ligand recognized by the BTA TRAK test. By contrast, FHR-1 in urine reduced the FH-dependent test signal.Conclusions: FH is a tumor marker for bladder cancer. To reveal the presence of bladder cancer, the BTA TRAK assay detects FH, whereas FHR-1 is able to partly inhibit this detection. This indicates a special mechanism for a diagnostic immunoassay based on the combined effect of simultaneous positive and negative signals in a single sample.
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Affiliation(s)
- Zhu-Zhu Cheng
- Department of Bacteriology and Immunology, Haartman Institute and HUSLAB, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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16
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Aguilera Tubet C, Gutiérrez Baños JL, Antolín Juárez F, Rebollo Rodrigo MH, Portillo Martín JA, Ruiz Izquierdo F, Ballestero Diego R, Martín García B. Estudio comparativo entre cistoscopia, citología urinaria, NMP-22 y un nuevo método, bladder chek, en el seguimiento del cáncer vesical superficial. Actas Urol Esp 2005; 29:252-6. [PMID: 15945249 DOI: 10.1016/s0210-4806(05)73235-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The goal of this work tries to evaluate the utility of the qualitative determination of NMP-22 in the evaluation of the superficial bladder carcinoma in asymptomatic patients, comparing it with its quantitative determination, the cytology and the cystoscopy. MATERIALS AND METHODS A simple of urine just voided was taken in 88 asymptomatic patient follow-up for superficial bladder cell carcinoma. This dose was distributed in 3 parts, for performed cytology, for determination of NMP-22, and 4 drops of the third part are added to device bladder chek. Later, we performed cystoscopy and transurethral resection in patients with a suspicion of bladder cancer. RESULTS 26 patients had tumor relapse and 62 patients were free of disease. The sensitivity for the bladder chek was of 28%, 34.62% for NMP-22, 34.62% for cytology and 100% for cystoscopy. The specificity was of 93.55%, 80.33%, 87.10% and 87.10% respectively. The sensitivity by degree was 25 in G1, 28.57 in G2 and 50 in G3 for Bladder chek; 29.41, 42.86 and 50 for NMP-22; 23.53, 71.43 and 0 for cytology. The sensitivity by stages was 27.7 in Ta-1 and 50 in T2 for Bladder chek; 34.78 and 50 for NMP-22; 39.13 and 0 for the cytology. CONCLUSIONS The low sensitivity of bladder chek invalidates it like alternative method to the cystoscopy in the follow-up of the superficial asymptomatic bladder cell carcinoma.
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Affiliation(s)
- C Aguilera Tubet
- Servicio de Urologia, Hospital Universitario Marqués de Valdecilla, Santander
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17
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Shariat SF, Casella R, Wians FH, Ashfaq R, Balko J, Sulser T, Gasser TC, Sagalowsky AI. Risk stratification for bladder tumor recurrence, stage and grade by urinary nuclear matrix protein 22 and cytology. Eur Urol 2004; 45:304-13; author reply 313. [PMID: 15036675 DOI: 10.1016/j.eururo.2003.10.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To test the hypothesis that voided urinary levels of nuclear matrix protein 22 (NMP22) would add to the predictive ability of urine cytology in the diagnosis, staging and grading of bladder transitional cell carcinoma (TCC), and to evaluate the diagnostic performance of different NMP22 cut-points. MATERIALS NMP22 level and barbotage cytology were evaluated in voided urine specimens collected before cystoscopy from 302 subjects with a history of TCC, 32 subjects with benign urologic pathologies, and 10 healthy volunteers. RESULTS 180 patients (52%) had bladder TCC. Higher levels of NMP22 and positive cytology were independently associated with an increased risk of TCC, invasive stage, and high grade. The NMP22 value with equal sensitivity and specificity for prediction of bladder cancer was 6.5U/ml; for prediction of grade 3 TCC it was 13.5U/ml; and for prediction of invasive tumor stage it was 17.4U/ml. The NMP22 cut-point of 6.5U/ml outperformed the 10U/ml cut-point in all pathologic stages and grades. The diagnostic sensitivity of the cytology and NMP22 combined was superior across all pathologic stages and grades to that of either marker alone. NMP22 and cytology stratified patients into groups with significantly different risk for TCC presence, invasive stage, and high grade. CONCLUSIONS 6.5U/ml is a robust NMP22 cut-point for bladder cancer surveillance. The diagnostic sensitivities of the combined NMP22 and cytology for TCC presence, stage, and grade were significantly higher than those of single marker alone. The combination of urine cytology and NMP22 could be used to tailor the frequency of cystoscopic follow up.
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Affiliation(s)
- Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA.
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18
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Lahme S, Bichler KH, Feil G, Zumbrägel A, Götz T. Comparison of cytology and nuclear matrix protein 22 (NMP 22) for the detection and follow-up of bladder-cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 539:111-9. [PMID: 15088900 DOI: 10.1007/978-1-4419-8889-8_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVES This study was designed to determine the clinical usefulness of the Nuclear Matrix Protein 22 (NMP 22) Test for the detection of bladder cancer in comparison to urine cytology. METHODS One hundred sixty-four patients suffering from or being suspicious for bladder cancer and 64 healthy controls participated in a prospective study. Freshly voided spot urine samples were taken for cytological examination and determination of NMP 22-levels by enzyme-linked immunoassay. RESULTS Sensitivity to the NMP 22 Test according to the tumor grading was (results of cytology in parentheses): GI 25.0% (20.0%), G2 68.2% (59.1%), and G3 100.0% (66.7%); overall sensitivity was 62.5% (45.0%). Sensitivity according to superficial bladder cancer was 46.7% (36.7%), and to invasive bladder cancer 90.0% (70.0%). Specificity was 65.9% (88.9%). CONCLUSIONS NMP 22 is a reliable tool for detecting invasive bladder cancer. Results for the well-differentiated superficial bladder cancer occurring frequently are as poor as those obtained with cytology. In addition, benign lesions such as urolithiasis or urinary tract infection lead to false positive results. Therefore, cystoscopy has to be performed when trying to detect and follow-up bladder cancer.
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Affiliation(s)
- Sven Lahme
- Department of Urology, University of Tuebingen, Germany
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19
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Simon MA, Lokeshwar VB, Soloway MS. Current bladder cancer tests: unnecessary or beneficial? Crit Rev Oncol Hematol 2003; 47:91-107. [PMID: 12900004 DOI: 10.1016/s1040-8428(03)00074-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bladder cancer is currently diagnosed using cystoscopy and cytology in patients with suspicious signs and symptoms. These same tests are used to monitor patients with a history of bladder cancer for recurrence. The recurrence rate for bladder cancer is high, thus necessitating long-term follow-up. Urine cytology requires an experienced cytopathologist and is costly. It has high specificity, but low sensitivity for low-grade bladder tumors. Recently many non-invasive bladder cancer tests, utilizing markers found in the urine, have been developed. The FDA has approved several of these for the use is bladder cancer diagnosis, and many others are undergoing development and investigation. An ideal bladder cancer test would be non-invasive, highly sensitive and specific, inexpensive, easy to perform, and yield highly reproducible results. Many of the tests reviewed meet some, but not all, of these criteria.
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Affiliation(s)
- Michael A Simon
- Scott Department of Urology, Baylor College of Medicine, 6560 Fannin Street, Suite 2100, Houston, TX 77030-2769, USA.
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Lotan Y, Roehrborn CG. Sensitivity and specificity of commonly available bladder tumor markers versus cytology: results of a comprehensive literature review and meta-analyses. Urology 2003; 61:109-18; discussion 118. [PMID: 12559279 DOI: 10.1016/s0090-4295(02)02136-2] [Citation(s) in RCA: 322] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To determine the clinical utility of urine-based bladder tumor markers (UBBTMs) and cytology in the treatment of patients with transitional cell carcinoma on the basis of their statistical performance. METHODS A comprehensive literature review was performed using Medline (1966 to current) and other search engines. Data regarding the statistical performance of UBBTMs were double extracted and rectified. Studies addressing comparable patient populations were combined and hierarchical Bayesian meta-analyses performed to calculate the sensitivity and specificity of commonly used UBBTMs, as well as urinary cytology. Patient populations were stratified by tumor stage and grade when data were presented in an extractable fashion. RESULTS The literature review yielded 54 publications, 338 distinct patient groups (controls, screening population, patients with cancer, strata based on grade and stage) and more than 10,000 patients. The number of groups varied from 1 to 18, and the number of patients ranged from less than 100 to more than 1500 for the various markers. All UBBTMs have better sensitivity compared with cytology, especially for low-grade/stage disease, but do not match cytology regarding specificity. In patients with grade 1 and 2 tumors, several UBBTMs are significantly superior statistically in terms of sensitivity compared with cytology. The sensitivity for transitional cell carcinoma in situ (Tis) is surprisingly poor for all UBBTMs. CONCLUSIONS UBBTMs can be used for follow-up of low-grade/stage tumors but should not replace cystoscopy. All UBBTMs have better sensitivity than cytology and could potentially replace routine cytology during patient follow-up.
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Affiliation(s)
- Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9110, USA
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21
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Abstract
BACKGROUND Genitourinary cancers account for more than 20% of all malignancies in the United States. These cancers do not usually yield rapid mortality, thereby necessitating longer-term surveillance strategies. METHODS A review and analysis of relevant studies were performed. Follow-up strategies are proposed to reflect effective methods to detect recurrent prostate, bladder, renal, and testicular cancers. Cost analysis was performed using Medicare reimbursement rates. RESULTS For genitourinary tumors, follow-up tests can be planned rationally based on detection rates and patterns. Tumor grade and stage drive follow-up strategies, along with therapeutic implications of detecting a recurrence. Symptomatic recurrences often obviate the need for radiographic tests and can minimize costs. Stage- specific plans for these four urologic malignancies are outlined specifically. CONCLUSIONS Not all surveillance approaches have been critically tested for follow-up of genitourinary tumors, but ample data are available to propose sound medical and economic strategies.
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Affiliation(s)
- Christopher P Evans
- Department of Urology, University of California, Davis, School of Medicine, Sacramento, California 95817, USA.
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22
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Gutiérrez Baños JL, Rebollo Rodrigo MH, Antolín Juárez FM, Martín García B. NMP 22, BTA stat test and cytology in the diagnosis of bladder cancer: a comparative study. Urol Int 2001; 66:185-90. [PMID: 11385303 DOI: 10.1159/000056612] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the usefulness of the NMP 22 and BTA stat test in the diagnosis and follow-up of bladder cancer and to compare these tests to cytology and cystoscopy, routine diagnostic methods. METHODS 150 patients followed up for bladder cancer or symptoms suggestive of bladder cancer underwent cystoscopy after cytology, NMP 22 and BTA stat test using a recently voided urine sample. In suspect cases, TUR and histopathological analysis were performed. RESULTS Bladder cancer was proven in 76 patients and excluded in 74. For NMP 22 we have used the cutoff value recommended by the manufacturer (10 U/ml) and that obtained by our receiver-operating characteristic curve (6 U/ml). Sensitivity was 84.21% for NMP 22 at the cutoff value of 6 U/ml and 76.32% with 10 U/ml; 72.37% for BTA stat test; 69.74% for cytology, and 100% for cystoscopy. Specificity was 86.49% for NMP 22 at a cutoff value of 6 U/ml and 90.54% at 10 U/ml; 89.19% for the BTA stat test; 93.24% for cytology and 89.19% for cystoscopy. NMP 22 sensitivity for grades 1, 2, and 3 was 68.75, 75.86 and 100%, respectively, at a cutoff value of 6 U/ml, and 50, 68.97 and 96.77%, respectively, at a cutoff level of 10 U/ml; for BTA stat the sensitivity was 56.25% in G1, 62.07% in G2 and 90.32% in G3, and for cytology the sensitivity was 43.75, 62.07 and 90.32%, respectively. The sensitivity of NMP 22 was 68.75% in stage Ta, 84.78% in T1 and 100% in T2-T4 at a cutoff level of 6 U/ml and 50, 80.43 and 92.86%, respectively, at a cutoff level of 10 U/ml; BTA stat sensitivity was 50% in Ta, 73.91% in T1 and 92.86% in T2-T4; and in cytology the results were 37.50, 73.91 and 85.71%, respectively. Using the McNemar test, there was only a significant difference between the sensitivity of NMP 22 at a cutoff level of 6 U/ml and cytology in the overall sample. CONCLUSIONS The high sensitivity of the NMP 22 and BTA stat test in combination with the data obtained from the parameters used for the evaluation of the test demonstrate their usefulness in the diagnosis and follow-up of bladder cancer. NMP 22 at a cutoff value of 6 U/ml is significantly more sensitive than cytology and consequently a thoroughly valid diagnostic tool in the diagnosis of bladder cancer which may substitute voided urine cytology.
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Affiliation(s)
- J L Gutiérrez Baños
- Department of Urology, 'Marqués de Valdecilla' University Hospital, Santander, Spain.
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23
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Lahme S, Bichler KH, Feil G, Krause S. Comparison of cytology and nuclear matrix protein 22 for the detection and follow-up of bladder cancer. Urol Int 2001; 66:72-7. [PMID: 11223747 DOI: 10.1159/000056574] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study was designed to determine the clinical usefulness of the nuclear matrix METHODS 84 patients suffering from bladder cancer or suspected bladder cancer, 25 patients with benign urological lesions and 60 healthy controls participated in a prospective study. Freshly voided spot urine samples were taken for cytological examination and determination of NMP 22 levels by enzyme-linked immunoassay. RESULTS The sensitivity of the NMP 22 test according to the tumor grading was (results of cytology in brackets): G1 25.0% (20.0%); G2 68.2% (59.1%), and G3 100.0% (66.7); overall sensitivity was 62.5% (45.0%). The sensitivity for superficial bladder cancer was 46.7% (36.7%) and for invasive bladder cancer 90.0% (70.0%). The specificity was 65.9% (88.9%). CONCLUSIONS NMP 22 is a reliable tool for detecting invasive bladder cancer. Results for the frequently occurring low grade superficial bladder cancer are as poor as those obtained with cytology. In addition benign lesions such as urolithiasis or urinary tract infection lead to false-positive results. Therefore cystoscopy has to be performed when trying to detect and follow-up bladder cancer.
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Affiliation(s)
- S Lahme
- Department of Urology, University of Tübingen, Hoppe-Seyler-Strasse 3, D-72076 Tübingen, Germany.
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COMPARATIVE PREDICTIVE VALUES OF URINARY CYTOLOGY, URINARY BLADDER CANCER ANTIGEN, CYFRA 21-1 AND NMP22 FOR EVALUATING SYMPTOMATIC PATIENTS AT RISK FOR BLADDER CANCER. J Urol 2001. [DOI: 10.1097/00005392-200105000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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SÁNCHEZ-CARBAYO M, URRUTIA M, SILVA J, ROMANÍ R, DE BUITRAGO JGONZÁLEZ, NAVAJO J. COMPARATIVE PREDICTIVE VALUES OF URINARY CYTOLOGY, URINARY BLADDER CANCER ANTIGEN, CYFRA 21-1 AND NMP22 FOR EVALUATING SYMPTOMATIC PATIENTS AT RISK FOR BLADDER CANCER. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66328-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M. SÁNCHEZ-CARBAYO
- From the Servicio de Bioquímica and Servicio de Urologia, Hospital Universitario de Salamanca, Salamanca, Spain
| | - M. URRUTIA
- From the Servicio de Bioquímica and Servicio de Urologia, Hospital Universitario de Salamanca, Salamanca, Spain
| | - J.M. SILVA
- From the Servicio de Bioquímica and Servicio de Urologia, Hospital Universitario de Salamanca, Salamanca, Spain
| | - R. ROMANÍ
- From the Servicio de Bioquímica and Servicio de Urologia, Hospital Universitario de Salamanca, Salamanca, Spain
| | - J.M. GONZÁLEZ DE BUITRAGO
- From the Servicio de Bioquímica and Servicio de Urologia, Hospital Universitario de Salamanca, Salamanca, Spain
| | - J.A. NAVAJO
- From the Servicio de Bioquímica and Servicio de Urologia, Hospital Universitario de Salamanca, Salamanca, Spain
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LOKESHWAR VINATAB, SOLOWAY MARKS. CURRENT BLADDER TUMOR TESTS: DOES THEIR PROJECTED UTILITY FULFILL CLINICAL NECESSITY? J Urol 2001. [DOI: 10.1016/s0022-5347(05)66428-2] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- VINATA B. LOKESHWAR
- From the Departments of Urology and Cell Biology and Anatomy, University of Miami School of Medicine, Miami, Florida
| | - MARK S. SOLOWAY
- From the Departments of Urology and Cell Biology and Anatomy, University of Miami School of Medicine, Miami, Florida
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27
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28
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Gutiérrez Baños JL, del Henar Rebollo Rodrigo M, Antolín Juárez FM, García BM. Usefulness of the BTA STAT Test for the diagnosis of bladder cancer. Urology 2001; 57:685-9. [PMID: 11306381 DOI: 10.1016/s0090-4295(00)01090-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the usefulness of the Bard BTA stat Test in the diagnosis and follow-up of bladder cancer and to compare this test to cytologic analysis and cystoscopy, routine diagnostic methods. METHODS Three hundred seventy-nine patients being followed up because of bladder cancer or with symptoms suggestive of bladder cancer underwent cystoscopy, cytologic analysis, and the BTA stat Test using a recently voided urine sample. In suspected cases, transurethral resection and histopathologic analysis were performed. RESULTS Of the 379 patients, 235 proved to have bladder cancer and 144 did not. The sensitivity was 73.62% for the BTA stat, 61.70% for cytologic examination, and 99.57% for cystoscopy. The specificity was 83.33% for the BTA stat, 92.36% for cytologic analysis, and 85.42% for cystoscopy. The BTA stat Test's sensitivity for grades 1, 2, and 3 tumor was 47.27%, 69.15%, and 95.35%, respectively. The sensitivity of cytologic analysis was 30.91%, 55.32%, and 88.37%. The BTA stat Test's sensitivity for stage was 45.65% in Stage Ta, 75.52% in T1, and 95.56% in Stage T2-4; the cytologic results were 28.26%, 65.03%, and 84.44%, respectively. The combination of both tests improved the sensitivity and decreased the specificity slightly. CONCLUSIONS The high sensitivity of the BTA stat Test, together with the data obtained from the parameters used for the evaluation of the test, demonstrate the better results of the BTA stat Test compared with cytologic analysis, making it a thoroughly valid diagnostic tool in the diagnosis of bladder cancer. In our opinion, the BTA stat Test can replace the use of cytologic analysis in the diagnosis of bladder cancer, but not the use of cystoscopy.
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Affiliation(s)
- J L Gutiérrez Baños
- Department of Urology, "Marqués de Valdecilla" University Hospital, Santander, Spain
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29
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Priolo G, Gontero P, Martinasso G, Mengozzi G, Formiconi A, Pelucelli G, Zitella A, Casetta G, Viberti L, Aimo G, Tizzani A. Bladder tumor antigen assay as compared to voided urine cytology in the diagnosis of bladder cancer. Clin Chim Acta 2001; 305:47-53. [PMID: 11249922 DOI: 10.1016/s0009-8981(00)00416-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The study was aimed at comparing the diagnostic accuracy of the quantitative bladder tumor antigen (BTA) TRAK immunoassay with exfoliative urine cytology in the detection of primary and recurrent bladder cancer. METHODS The analysis was carried out on 194 high risk patients undergoing a diagnostic cystoscopy, 279 patients with previous history of transitional cell carcinoma awaiting a follow-up cystoscopy, and 45 healthy controls. Urine cytology was performed by a skilled cytopathologist on three consecutive samples. RESULTS BTA TRAK values resulted significantly higher in tumor positive cases than in absence of bladder tumor for both groups of patients. Non neoplastic urothelial diseases as well as the absence of mucosal abnormalities were associated with a marked increase in BTA TRAK levels with respect to the control group. Overall sensitivity and specificity was 63 and 63% for BTA TRAK (cut-off 34 U/ml), and 68.3 and 73.4% for urine cytology, respectively. The diagnostic advantage of urine cytology was maintained when patients were stratified by tumor grade. CONCLUSIONS The clinical performance of the BTA TRAK in the detection of primary or recurrent bladder cancer is acceptable and reproducible as shown by similar results with previous reports, although urine cytology performed on three samples showed the highest sensitivity and specificity.
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Affiliation(s)
- G Priolo
- Laboratory of Clinical Chemistry, San Giovanni Battista Hospital, Corso Bramante 88, 10126, Turin, Italy.
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30
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Casetta G, Gontero P, Zitella A, Pelucelli G, Formiconi A, Priolo G, Martinasso G, Mengozzi G, Aimo G, Viberti L, Tizzani A. BTA quantitative assay and NMP22 testing compared with urine cytology in the detection of transitional cell carcinoma of the bladder. Urol Int 2001; 65:100-5. [PMID: 11025432 DOI: 10.1159/000064848] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Both BTA TRAK and NMP22 urine concentrations have shown a sensitivity superior to urine cytology in the detection of bladder cancer. We compared these tumor markers with urine cytology performed on 3 consecutive samples and evaluated by an expert cytopathologist. PATIENTS AND METHODS The investigations were conducted on 94 patients undergoing a diagnostic cystoscopy for a high suspicion of bladder cancer (group 1) and on 102 patients with previous history of transitional cell carcinoma awaiting a follow-up cystoscopy (group 2). Biopsy specimens were obtained also from tumor negative patients. Immunoassays for BTA TRAK and NMP22 were carried out according to standard methods. The choice of the cut-off was based on the ground of sensitivity and specificity curves intersection. Urine cytology results were expressed as positive, negative and 'dubious'. RESULTS Overall sensitivity was 56% for NMP22 (cut-off 11 U/ml) and 57% for BTA TRAK (cut-off 60 U/ml). When dubious results were considered as positive cases, urine cytology achieved a sensitivity of 73.3%. Assuming dubious cases as negative results, urine cytology sensitivity resulted 59.3%. When the 2 groups of patients were evaluated separately with different cut-off, there was no significant gain in sensitivity for BTA TRAK and NMP22 over urine cytology. CONCLUSIONS Urine cytology performed on 3 samples showed the highest sensitivity and specificity. The diagnostic advantage of urine cytology over BTA TRAK and NMP22 was maintained when patients were stratified by tumor grade.
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Affiliation(s)
- G Casetta
- Department of Urology, University of Torino, Italy.
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CASELLA ROBERTO, HUBER PETER, BLÖCHLINGER ANDREA, STOFFEL FLAVIO, DALQUEN PETER, GASSER THOMASC, LEHMANN KURT. URINARY LEVEL OF NUCLEAR MATRIX PROTEIN 22 IN THE DIAGNOSIS OF BLADDER CANCER: : EXPERIENCE WITH 130 PATIENTS WITH BIOPSY CONFIRMED TUMOR. J Urol 2000. [DOI: 10.1016/s0022-5347(05)66920-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- ROBERTO CASELLA
- From the Urologic Clinic, Department of Central Laboratories and Institute for Pathology, University Hospital Basel and Urologic Clinic, Kantonsspital Baden, Basel, Switzerland
| | - PETER HUBER
- From the Urologic Clinic, Department of Central Laboratories and Institute for Pathology, University Hospital Basel and Urologic Clinic, Kantonsspital Baden, Basel, Switzerland
| | - ANDREA BLÖCHLINGER
- From the Urologic Clinic, Department of Central Laboratories and Institute for Pathology, University Hospital Basel and Urologic Clinic, Kantonsspital Baden, Basel, Switzerland
| | - FLAVIO STOFFEL
- From the Urologic Clinic, Department of Central Laboratories and Institute for Pathology, University Hospital Basel and Urologic Clinic, Kantonsspital Baden, Basel, Switzerland
| | - PETER DALQUEN
- From the Urologic Clinic, Department of Central Laboratories and Institute for Pathology, University Hospital Basel and Urologic Clinic, Kantonsspital Baden, Basel, Switzerland
| | - THOMAS C. GASSER
- From the Urologic Clinic, Department of Central Laboratories and Institute for Pathology, University Hospital Basel and Urologic Clinic, Kantonsspital Baden, Basel, Switzerland
| | - KURT LEHMANN
- From the Urologic Clinic, Department of Central Laboratories and Institute for Pathology, University Hospital Basel and Urologic Clinic, Kantonsspital Baden, Basel, Switzerland
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URINARY LEVEL OF NUCLEAR MATRIX PROTEIN 22 IN THE DIAGNOSIS OF BLADDER CANCER:. J Urol 2000. [DOI: 10.1097/00005392-200012000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Gutiérrez Baños JL, Rebollo Rodrigo MH, Antolín Juárez F, Martín García B, Hernández Rodríguez R, Portillo Martín JA, Correas Gómez MA, Del Valle Schaan JI, Roca Edreira A, De Diego Rodríguez E, Rado Velázquez MA, Hernández Castrillo A. [NMP-22 in the diagnosis of bladder cancer]. Actas Urol Esp 2000; 24:715-20. [PMID: 11132442 DOI: 10.1016/s0210-4806(00)72533-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the usefulness of the NMP-22 test in the diagnosis of bladder cancer; to calculate the ideal cutoff and to compare the results among NMP-22, voided urine cytology and cystoscopy. MATERIAL AND METHODS 166 patients having clinical suspicious of bladder cancer or in follow-up due to a previous one. The exclusions criteria were: other urological conditions, radiotherapy in the last three months, systemic chemotherapy in the last month, recent vesical trauma or indwelling catheter. Prior cystoscopy a recent voided urinary sample was sent to the pathology and biochemistry laboratory to perform cytology and NMP-22. A TUR was performed in patients with bladder tumour. The cutoff was calculated with ROC curves. For each test we calculate sensitivity, specificity, positive and negative predictive value. We use the McNemar test to compare the results, all of which are expressed with a confidence interval of 95%. RESULTS The ideal cutoff was 6 U/ml. We have a global sensitivity of 82.75% for NMP-22 and 67.9 for cytology (p = 0.0118); the specificity was 80% and 94.12% respectively (p = 0.0018). By grade the sensitivity was 72.22% G1, 70.97% G2 and 100% G3 for NMP-22 and 44.44%, 58.06% and 90.62% for cytology. By stage it was 68.42% Ta, 83.33% T1 and 100 T2 or more for NMP-22 and 36.84%, 75% and 85.71% for cytology. With the cystoscopy we obtained a 100% sensitivity and 89.41% specificity. CONCLUSIONS The NMP-22 is a useful test for the diagnosis of bladder cancer; is more sensitive and less specific than cytology. We think it can replace the cytology in the diagnosis and follow-up of bladder cancer. The ideal cutoff is 6 U/ml.
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Affiliation(s)
- J L Gutiérrez Baños
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander
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Abstract
Transitional cell carcinoma of the bladder is comprised of a variety of cancer diatheses that manifest a spectrum of distinct biologic potentials. The challenge is to control superficial disease recurrence and progression and to identify invasive carcinoma at an earlier stage, when it may be more amenable to cure.
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Affiliation(s)
- W Hassen
- Department of Urology, Mount Sinai Medical Center, New York, New York 10029-6574, USA
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Abstract
Bladder cancer is a common disease that causes significant morbidity and mortality in the United States. Early detection and routine surveillance are recommended in the management of this chronic and recurrent disease. Cystoscopic examination has been used for detection and follow-up; however, it is costly and is associated with patient discomfort. With advances in molecular biology and biochemistry, many diagnostic assays have been developed to supplement cystoscopy. The mechanisms and variable results of these assays are described. In addition, the economic and social implications of bladder cancer detection and surveillance are discussed.
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36
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Grocela JA, McDougal WS. Utility of nuclear matrix protein (NMP22) in the detection of recurrent bladder cancer. Urol Clin North Am 2000; 27:47-51, viii. [PMID: 10696244 DOI: 10.1016/s0094-0143(05)70233-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article examines the Nuclear Matrix Protein (NMP22) urine test for recurrent bladder cancer detection. Studies with NMP22 are compared to cytology for sensitivity and specificity. False positives and false negatives do occur, and consequences of these are discussed. Speculations are made regarding possible future uses of this test.
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Affiliation(s)
- J A Grocela
- Department of Urology, Harvard Medical School, Boston, Massachusetts, USA
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