Non-Invasive Diagnostic Tests for Bladder Cancer: A Review of the Literature

Bassi, Pierfrancesco; Marco, Vincenzo De; Lisa, Antonello De; Mancini, Mariangela; Pinto, Francesco; Bertoloni, R.; Longo, Fabrizio

doi:10.1159/000087792

Cited by 59 publications

(33 citation statements)

References 93 publications

(39 reference statements)

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“…The performance of cytology has been criticized due to its low sensitivity with substantial variability (in the range of 23.0–75.0%) [1,2,3,4,5,6,7,8]. Sensitivity is known to be lower for low-grade tumors than for high-grade ones [1,2,6,7,9,10].…”

Section: Introductionmentioning

confidence: 99%

Is Conventional Urinary Cytology Still Reliable for Diagnosis of Primary Bladder Carcinoma? Accuracy Based on Data Linkage of a Consecutive Clinical Series and Cancer Registry

et al. 2011

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Objective: Reported urine cytology accuracy, particular sensitivity, is highly variable. We evaluated the accuracy of urinary cytology for primary bladder cancer using population data linkage to provide valid estimates. Study Design: Consecutive cytology tests processed through a major service between January 2000 and December 2004 were linked to a regional population cancer registry (allowing outcome ascertainment). Sensitivity and specificity were calculated using different thresholds, based on standardized reporting categories (C1 = negative, C2 = reactive, C3 = atypical, C4 = suspicious, C5 = malignant, Cx = inadequate). Results: Cancer registry matching of 2,594 tests revealed 130 incident bladder cancers, of which 97 occurred within 12 months of cytology and were included in calculating accuracy. Sensitivity (C3–C5 considered positive) ranged between 40.2 and 42.3%, and specificity was 93.7–94.1%. If C3 results are counted as negative, sensitivity estimates reduced to 24.7–26.0%. The positive predictive value of a C3, C4 or C5 report was 11.7, 39.2, and 66.6%, respectively. High tumor grade was associated with significantly higher sensitivity compared to low and intermediate grades combined (p = 0.02). Conclusion: Urine cytology is highly specific but has intermediate sensitivity, indicating that it has a role in adjunct diagnosis, but not in screening for primary bladder cancer. C3 results should be considered ‘positive’ and further investigated, and all positive results should prompt further intervention.

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Section: Introductionmentioning

confidence: 99%

Is Conventional Urinary Cytology Still Reliable for Diagnosis of Primary Bladder Carcinoma? Accuracy Based on Data Linkage of a Consecutive Clinical Series and Cancer Registry

et al. 2011

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“…Here, several studies have evaluated the efficacy of urinary markers as non-invasive tools. Bassi et al [25] stated that most of the markers tend to be less specific but more favorable in terms of sensitivity compared to urinary cytology. Another comparative study focusing on NMP22, BTA stat test and cytology ascribed NMP22 a higher sensitivity than cytology [26].…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Gender-Related Differences in Symptoms and Referral Patterns prior to Initial Diagnosis of Urothelial Carcinoma of the Bladder: A Prospective Cohort Study

et al. 2014

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Objective: To analyze gender-specific differences regarding clinical symptoms, referral patterns and tumor biology prior to initial diagnosis of urothelial carcinoma of the bladder (UCB). Methods: A consecutive series of patients with an initial diagnosis of UCB was included. All patients completed a questionnaire on demographics, clinical symptoms and referral patterns. Results: In total, 68 patients (50 men, 18 women) with newly diagnosed UCB at admission for transurethral resection of bladder tumors were recruited. Dysuria was more often observed in women (55.6 vs. 38.0%, p = 0.001). Direct consultation of the urologist was conducted by 84.0% of males and 66.7% of females (p = 0.120). One third of the women saw their general practitioner and/or gynecologist once or twice (p = 0.120) before referral to the urologist. Furthermore, women were significantly more often treated for urinary tract infections than men (61.1 vs. 20.0%, p = 0.005). Cystoscopy at first presentation to the urologist was more often performed in men than women (88.0 vs. 66.7%, p = 0.068), with a more favorable tumor detection rate at first cystoscopy in men (96.0 vs. 50.0%, p < 0.001). Conclusions: Delayed referral patterns might lead to deferred diagnosis of UCB and consequently to adverse outcome. Thus, primary care physicians might consider referring patients with bladder complaints to specialized care earlier.

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“…While urine Cyt, in which urine or cells washed from the bladder are tested for the presence of pre-cancer cells or cancer cells, is a non-invasive test, it is limited by low sensitivity of 40% for low-grade tumors [2]. A literature search indicates the presence of many molecular biomarkers for bladder cancer [3,4]; however, none has proven to be sensitive and specific enough to replace cystoscopy [5]; 'Few if any of molecular markers for bladder cancer are widely used in clinical practice' [6], and 'Most markers tend to be less specific than Cyt, yielding more falsepositive results' [4]. It has been stated that 'We have more to accomplish before biomarkers can be considered part of the clinical management of more advanced diseases' [7].…”

Section: The Current State Of Biomarker Discoverymentioning

confidence: 99%

Cancer biomarker discovery: Opportunities and pitfalls in analytical methods

2011

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Many diseases result in specific and characteristic changes in the chemical and biochemical profiles of biological fluids and tissues prior to development of clinical symptoms. These changes are often useful diagnostic and prognostic biomarkers. Identifying biomarkers that can be used for the early detection of cancer will result in more efficient treatments, reduction in suffering, and lower mortality rates. An ideal screening test should be non-invasive with high sensitivity and specificity. Proteomic and metabolomic analyses of biological samples can reveal changes in abundance levels of metabolites and proteins that when validated and confirmed through clinical trials can function as clinical tests for early detection, diagnosis, monitoring disease progression, and predicting therapeutic response. While the past decade has seen great advancements in proteomics and metabolomics research producing potential biomarkers for cancer, most of the identified biomarkers have failed to replace existing clinical tests. To become a clinically approved test, a potential biomarker should be confirmed and validated using hundreds of specimens and should be reproducible, specific, and sensitive. A search of the scientific and medical literature indicates that many studies report the discovery of potential biomarkers without proper validation and/or they do not meet the above criteria. In this manuscript, we will discuss the successes and the pitfalls of biomarker research and comment on study and experimental design, which in most cases is lacking, resulting in suboptimal biomarkers.

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Non-Invasive Diagnostic Tests for Bladder Cancer: A Review of the Literature

Cited by 59 publications

References 93 publications

Is Conventional Urinary Cytology Still Reliable for Diagnosis of Primary Bladder Carcinoma? Accuracy Based on Data Linkage of a Consecutive Clinical Series and Cancer Registry

Is Conventional Urinary Cytology Still Reliable for Diagnosis of Primary Bladder Carcinoma? Accuracy Based on Data Linkage of a Consecutive Clinical Series and Cancer Registry

Comparative Analysis of Gender-Related Differences in Symptoms and Referral Patterns prior to Initial Diagnosis of Urothelial Carcinoma of the Bladder: A Prospective Cohort Study

Cancer biomarker discovery: Opportunities and pitfalls in analytical methods

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