BTA quantitative assay and NMP22 testing compared with urine cytology in the detection of transitional cell carcinoma of the bladder

Purpose: Both BTA TRAK and NMP22 urine concentrations have shown a sensitiv ity superior to urine cytology in the detection of bladder cancer. We compa red these tumor markers with urine cytology performed on 3 consecutive samp les and evaluated by an expert cytopathologist. Patients and Methods: The i nvestigations were conducted on 94 patients undergoing a diagnostic cystosc opy for a high suspicion of bladder cancer (group 1) and on 102 patients wi th previous history of transitional cell carcinoma awaiting a follow-up cys toscopy (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 sen sitivity and specificity curves intersection, Urine cytology results were e xpressed as positive, negative and 'dubious', Results: Overall sensitivity was 56% for NMP22 (cut-off 11 U/ml) and 57% for BTA TRAK (cutoff 60 U/ml). When dubious results were considered as positive cases, urine cytology achi eved a sensitivity of 73.3%. Assuming dubious cases as negative results, ur ine 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: Ur ine cytology performed on 3 samples showed the highest sensitivity and spec ificity. The diagnostic advantage of urine cytology over BTA TRAK and NMP22 was maintained when patients were stratified by tumor grade. Copyright (C) 2000 S. Karger AG, Basel.