A study comparing various noninvasive methods of detecting bladder cancer in urine

Abstract

Objectives To compare the nuclear matrix protein (NMP)-22 assay, bladder tumour speci®c antigen (BTAstat) test, telomerase activity (using the telomeric repeat ampli®cation protocol assay, TRAP) and a haemoglobin dipstick test for their ability to replace voided urine cytology (VUC) for detecting bladder cancer. Patients and methods The study included 120 urological patients prospectively recruited and assessed before surgery. A single freshly voided urine sample (<100 mL) was collected from each patient and aliquoted for each test. All assays were conducted according to the manufactures' guidelines; 79 patients were tested for telomerase activity. The results were then compared with VUC and the diagnosis con®rmed by cystoscopy and histology. Results Fifty-two patients had histologically con®rmed transitional cell carcinoma. The overall sensitivity for BTAstat, NMP22, telomerase, VUC and dipstick testing was 63%, 81%, 84%, 48% and 50%, respectively. Combining the results for telomerase and NMP22 gave a sensitivity of 100%. For G1 tumours the respective sensitivities were 23%, 62%, 56%, 23% and 15%, for G2 tumours, 68%, 86%, 92%, 50% and 41% and for G3 tumours 88%, 88%, 100%, 71% and 82%. For pTa tumours the respective detection rates were 48%, 70%, 84%, 39% and 30%, for pT1 tumours 80%, 90%, 90%, 50% and 50%, for pT2/ pTis tumours, 100/100%, 100/100%, 100/100%, 88/100% and 88/83%. The overall speci®city for the respective tests was 82%, 87%, 93%, 87% and 54%; combining the results of NMP22 and telomerase activity increased the speci®city to 96%. Conclusions There was signi®cantly better detection than VUC when using the NMP22 and TRAP assay, especially for well-differentiated (P<0.001 and 0.0027, respectively) and super®cial tumours (P<0.001 and 0.034, respectively). Combining the results of NMP22 and telomerase activity yielded values comparable with cystoscopy.

Differential response of normal and malignant urothelial cells to CHK1 and ATM inhibitors

“…Furthermore, approximately 30% of cases will progress to muscle-invasive cancers and result in life threatening from distant metastases (Saad et al, 2002). …”

Bladder Cancer in 2010: How Far have We Come?

“…1 Of newly diagnosed bladder cancer cases, approximately 70%-80% will present with nonmuscle-invasive disease, and despite endoscopic and intravesical treatments, 50%-70% will recur and 10%-30% will progress to muscle-invasive disease. 2,3 Most recurrences occur within 5 years. 4 Higher grade lesions are at a greater risk for tumor progression.…”

The use of Urovysion™ fluorescence in situ hybridization in the diagnosis and surveillance of non-urothelial carcinoma of the bladder

“…7 The gold standard for diagnosis and surveillance of urothelial carcinoma has traditionally been cystoscopy and urine cytology, however both have limitations. [8][9][10][11][12][13][14] Although urine cytology is excellent for detecting high-grade urothelial carcinoma (sensitivity and specificity 475%), it has a low sensitivity (20-60%) for detecting low-grade tumors. 8,[10][11][12][13][14] The low sensitivity of urine cytology, the invasiveness of cystoscopy and its limited usefulness in detecting flat and inaccessible lesions have prompted increased demand for newer, more sensitive and non-invasive tests for detection of urothelial carcinoma.…”

“…This has led to the development of new sophisticated molecular techniques that have a higher sensitivity and specificity for urothelial carcinoma detection. 12,15 One such technique is the now commercially available multicolor, multitarget Urovysiont fluorescence in situ hybridization (Urovysiont FISH) assay that was created by Vysis Incorporated (Vysis-Abbot Laboratories, Downers Grove, IL, USA). 16 Urovysiont FISH is the first molecular test that uses DNA probes to identify the most common urothelial carcinomarelated chromosomal abnormalities in urine.…”