Comparison of screening methods in detection of bladder cancer

Purpose: We prospectively evaluate and compare the sensitivity and specific ity of urine cytology, BTA stat,dagger NMP22,double dagger fibrin/fibrinoge n degradation products (FDP), telomerase, chemiluminescent hemoglobin and h emoglobin dipstick to detect bladder cancer. Materials and Methods: Single voided specimens were obtained from 57 patien ts with bladder cancer, and 139 without evidence of bladder malignancy on c ystoscopy or a negative biopsy of indeterminate lesions. A cytology report was available for 125 patients and interpreted independently . BTA slat, NM P22 and FDP were analyzed according to manufacturer specifications. The tel omerase assay was performed on cells collected from urine by centrifugation in preparation for polymerase chain reaction based amplification using the telomeric repeat amplification protocol assay. The chemiluminescent screen ing assay for hemoglobin in urine uses the pseudoperoxidase activity of hem oglobin on hydrogen peroxide and subsequent oxidation of 7-dimethylaminonap hthalene-1,2-dicarbonic acid hydrazide to generate chemiluminescence emissi on. Hemoglobin dipstick was interpreted as positive if the hemoglobin conte nt in the urine was trace or greater. Results: Overall sensitivity with urine cytology, BTA stat, NMP22, FDP, tel omerase, chemiluminescent hemoglobin and the hemoglobin dipstick was 44, 74 , 53, 52, 70, 67 and 47%, respectively. Specificity with cytology, telomera se and FDP was high (95, 99 and 91%, respectively) but BTA stat, NMP22 (opt imized), chemiluminescent hemoglobin (optimized) and the hemoglobin dipstic k demonstrated lower specificity of 73, 60, 63 and 84%, respectively. Stepw ise logistic regression analysis revealed that for all tumors, and within e ach tumor grade and stage telomerase had the strongest association with bla dder cancer among all tests (69% overall concordance). Telomerase was also positive in 91% of the patients (10 of 11) with carcinoma in situ. Conclusions: Urinary telomerase had the highest combination of sensitivity and specificity (70 and 99%, respectively) for bladder cancer screening in these patients. It was the strongest predictor with superior accuracy in pa tients with grade 1 and noninvasive tumors (pTa), and extremely useful in p atients with carcinoma in situ. Telomerase appears to be promising and outp erformed cytology, BTA stat, NMP22, FDP, chemiluminescent hemoglobin and he moglobin dipstick in the prediction of bladder cancer.