The BTA stat test: A tumor marker for the detection of upper tract transitional cell carcinoma

Objectives. To conduct a prospective evaluation to determine the utility of the BTA stat test in the detection of upper tract transitional cell carcin oma (UTTCC). Monitoring for UTTCC currently relies on invasive procedures s uch as upper tract imaging, ureteral washing cytology (UWC) and/or ureteros copy, or voided urine cytology (VUC). The BTA stat test is a sensitive qual itative immunoassay that detects human complement factor H-related protein in voided urine. Methods. A total of 81 patients participated, 27 with histopathologically c onfirmed UTTCC, 26 with upper tract calculi, and 28 with microscopic hematu ria but no evidence of urologic disease. Voided specimens collected before surgery or treatment were tested with the BTA stat test and VUC. UWC was pe rformed in specimens collected by a ureteral catheter. Results. The BTA stat test was significantly more sensitive and specific th an VUC or UWC. The overall sensitivity for each was 82%, 11%, and 48%; the specificity was 89%, 54%, and 33%. The positive predictive value for the BT A stat test was 79% and the negative predictive value was 91%, both the hig hest of the three tests. Conclusions. The BTA stat test was superior to VUC and UWC in the detection of UTTCC. These results may support the adoption of a less aggressive foll ow-up policy when monitoring for UTTCC when the BTA stat result is negative . If cystoscopy is negative and the BTA stat test is positive, upper tract investigations should be expedited and, if the bladder is in place, bladder biopsies performed. (C) 2001, Elsevier Science Inc.