1171 COMBINATION OF URINE-BASED TUMOR MARKERS AND URINE CYTOLOGY IN THE DETECTION OF TRANSITIONAL CARCINOMA
2010-03-23

You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20101171 COMBINATION OF URINE-BASED TUMOR MARKERS AND URINE CYTOLOGY IN THE DETECTION OF TRANSITIONAL CARCINOMA Christian Schwentner, Joerg Hennenlotter, Ursula Kuehs, Henriette Sleiman, Daniela Colleselli, Severine Huber, David Schilling, Karl-Dietrich Sievert, and Arnulf Stenzl Christian SchwentnerChristian Schwentner More articles by this author , Joerg HennenlotterJoerg Hennenlotter More articles by this author , Ursula KuehsUrsula Kuehs More articles by this author , Henriette SleimanHenriette Sleiman More articles by this author , Daniela ColleselliDaniela Colleselli More articles by this author , Severine HuberSeverine Huber More articles by this author , David SchillingDavid Schilling More articles by this author , Karl-Dietrich SievertKarl-Dietrich Sievert More articles by this author , and Arnulf StenzlArnulf Stenzl More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.671AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The number of noninvasive diagnostic tests for transitional cell carcinoma (TCC) has increased tremendously over the last years with a large number of experimental and commercial tests being available. However, their relevance in the diagnostic regimen remains to be discussed. These tests are usually combined with plain urinary cytology (Cyt). Still there are no recommendations on the preferred combinations. Herein, we evaluate whether addition of one of the urine based tumor markers uCyt+ (DiagnoCure), UroVysion (Vysis) or NMP22 ELISA (Matritech) to routine cytology Cyt increases the predictive value of urine-based tests for TCC. METHODS Urine Cyt and urine tests uCyt+ (DiagnoCure), UroVysion (Vysis) and NMP22 ELISA (Matritech) were performed in 723 patients without any history of TCC prior to cystoscopy with or without transurethral resection. Sensitivity, specificity and accuracy were determined for every single marker as well as for all possible combinations of Cyt with any of the aforementioned tests. Combinations were considered positive if at least one marker was positive and all tests regarding the respective combination were performed. Results were compared descriptively and interpreted for clinical use. RESULTS Histological evidence for TCC was found in 92 (12.7%) patients. The tumor stages were as follows: Ta 56.4%, T1 17.0%, ≥T2 24.1%. Of those, 34.2% were low-grade TCCs and 65.8% were high-grade TCCs. Overall sensitivity was 80.8%, 68.5%, 82.1% and 72.6% for Cyt, UroVsion, uCyt+ and NMP22, respectively. Specificity was 89.0%, 88.0%, 82.6% and 42.6%. Accuracy was 87.5%, 85.6%, 82.6% and 46.8%, respectively. If Cyt was combined with UroVysion, uCyt+ and NMP22 test sensitivities were 81.5%, 85.5% and 90.4%, respectively. Specifities were 84.6%, 76.7% and 39.2% while accuracy was 84.2%, 78.0% and 46.4%, respectively. CONCLUSIONS Within the evaluated cohort, sensitivity of the uCyt+ test was superior to the values of the remaining tests whereas cytology offers the best specifity as well as the highest accuracy. Every additional urine based marker increases the sensitivity of plain Cyt with NMP22 being most sensitive. However, especially in this combination specificity decreases dramatically. Given our data, the combination of Cyt and UroVysion is the most efficient combination with sensitivity, specificity and accuracy above 81%. Nevertheless, it is important to keep in mind that any adjunct to routine Cyt will decrease test specificity. Hence, individual decision-making is required to avoid unnecessary urinary tract instrumentation. Tuebingen, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e454 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Schwentner More articles by this author Joerg Hennenlotter More articles by this author Ursula Kuehs More articles by this author Henriette Sleiman More articles by this author Daniela Colleselli More articles by this author Severine Huber More articles by this author David Schilling More articles by this author Karl-Dietrich Sievert More articles by this author Arnulf Stenzl More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...