THE USE OF THE BLADDER-TUMOR ASSOCIATED ANALYTE TEST TO DETERMINE THETYPE OF CYSTOSCOPY IN THE FOLLOW-UP OF PATIENTS WITH BLADDER-CANCER

Objective To assess the use of the bladder-tumour associated analyte t est (BTA, Bard UK) to determine whether patients with bladder cancer s cheduled for cystoscopy under general anaesthesia can have local anaes thesia instead. Patients and methods A total of 272 patients who were scheduled for general anaesthesia cystoscopy were entered into a prosp ective multicentre study. The BTA test was performed on a specimen of freshly voided urine and the type of cystoscopy was determined accordi ng to whether the result was positive or negative. Patients with a neg ative BTA result were examined with the flexible instrument, under loc al anaesthesia, instead of the planned general anaesthetic cystoscopy. Results In 59 patients, the BTA test was positive and tumour was foun d (true positive), in 145 patients the test was negative and cystoscop y was negative (true negative), in 25 patients the test was positive a nd cystoscopy was negative (false positive) and in 43 patients, the te st was negative but tumour was found on flexible cystoscopy; the patie nt underwent subsequent cystoscopy under general anaesthesia (false ne gative). The sensitivity and specificity were 58% and 86%, respectivel y. The use of the BTA test resulted in fewer patients needing cystosco py under general anaesthesia and saved about pound 20 500 ($31 000) or pound 76 ($114) per patient. Conclusion The integration of the BTA te st into the follow-up of patients with bladder cancer may help to sele ct those suitable for cystoscopy under a local anaesthetic and this wi ll result in cost savings as well as sparing patients the more invasiv e procedure, The test is not sufficiently sensitive to replace cystosc opy and there were false-negative results despite high-grade recurrenc e. Thus, when the test is used as part of a follow-up programme, a tim ely back-up of cystoscopy under general anaesthesia should be arranged for patients with false-negative results.