1238 IMMUNOCYTOLOGY IS A STRONG PREDICTOR OF BLADDER CANCER PRESENCE IN PATIENTS WITH ASYMPTOMATIC HEMATURIA
2011-04-01

You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20111238 IMMUNOCYTOLOGY IS A STRONG PREDICTOR OF BLADDER CANCER PRESENCE IN PATIENTS WITH ASYMPTOMATIC HEMATURIA Eugene Cha, Lenuta-Ancuta Tirsar, Shahrokh Shariat, Douglas Scherr, Christian Schwentner, Joerg Hennenlotter, Arnulf Stenzl, Christine Mian, Paul Christos, Madhu Mazumdar, Michele Lodde, Armin Pycha, and Bernd Schmitz-Drager Eugene ChaEugene Cha New York, NY More articles by this author , Lenuta-Ancuta TirsarLenuta-Ancuta Tirsar Furth, Germany More articles by this author , Shahrokh ShariatShahrokh Shariat New York, NY More articles by this author , Douglas ScherrDouglas Scherr New York, NY More articles by this author , Christian SchwentnerChristian Schwentner Tuebingen, Germany More articles by this author , Joerg HennenlotterJoerg Hennenlotter Tuebingen, Germany More articles by this author , Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author , Christine MianChristine Mian Bolzano, Italy More articles by this author , Paul ChristosPaul Christos New York, NY More articles by this author , Madhu MazumdarMadhu Mazumdar New York, NY More articles by this author , Michele LoddeMichele Lodde Bolzano, Italy More articles by this author , Armin PychaArmin Pycha Bolzano, Italy More articles by this author , and Bernd Schmitz-DragerBernd Schmitz-Drager Furth, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.909AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ImmunoCyt immunocytology assay detects cellular biomarkers for bladder cancer (BCa) in exfoliated urothelial cells. The role of ImmunoCyt for BCa detection remains controversial. Therefore, we assessed the performance of ImmunoCyt for detecting BCa in a large multi-institutional cohort of patients undergoing initial evaluation for asymptomatic hematuria. METHODS Data from 1,182 consecutive subjects without a history of BCa undergoing evaluation for hematuria were collected at three centers. Clinical risk factors including age, gender, smoking status, and degree of hematuria were recorded. All subjects underwent standard workup (i.e., voided cytology, upper tract imaging, and cystoscopy) and immunocytology. Factors associated with the presence of BCa were evaluated by univariate and multivariable logistic regression analyses. Internal validation was performed using 200 bootstrap samples. RESULTS Overall, 245 subjects (20.7%) had BCa. The sensitivity/specificity/negative predictive value for ImmunoCyt and cytology were 82.4%/86.6%/95.0% and 46.5%/94.9%/87.2%, respectively. ImmunoCyt (OR 18.3, p<0.001), cytology (OR 2.9, p<0.001), age (OR 1.03, p<0.001), smoking status (OR 3.7, p<0.001), and degree of hematuria (OR 1.6, p=0.01) were associated with BCa in a multivariable analysis. The base model (age, gender, smoking status, degree of hematuria) predicted BCa with an accuracy of 74.1%. Addition of cytology to the base model (Model 1) improved predictive accuracy (PA) to 83.5% (p<0.001), while addition of ImmunoCyt to the base model (Model 2) improved PA to 90.1% (p<0.001). Addition of ImmunoCyt to the model with cytology significantly improved PA further (+7.6%, p<0.001), but addition of cytology to the model with ImmunoCyt did not (+1.0%, p=0.057). ImmunoCyt performed equally well in patients with microscopic and gross hematuria (OR 30 vs 27), in contrast to cytology (OR 18 vs 12). CONCLUSIONS ImmunoCyt is a strong, independent predictor of BCa presence in patients with hematuria; it outperforms cytology. Addition of ImmunoCyt into the clinical decision-making process may help with patient counseling, improve referral patterns (via increased awareness and prioritization), and possibly spare patients at extremely low risk of BCa from unnecessary hematuria workups. Base Model Model 1 Model 2 Model 3 Predictors OR p Value OR p Value OR p Value OR p Value Age 1.04 <0.001 1.03 <0.001 1.03 <0.001 1.03 <0.001 Gender 1.22 0.31 1.10 0.66 1.00 0.99 0.97 0.89 Smoker 3.17 <0.001 3.72 <0.001 3.38 <0.001 3.66 <0.001 Hematuria (gross vs micro) 1.90 <0.001 1.71 0.002 1.71 0.007 1.63 0.014 Cytology - - 14.71 <0.001 - - 2.92 <0.001 ImmunoCyt - - - - 27.71 <0.001 18.26 <0.001 Predictive Accuracy 74.1% 83.5% 90.1% 91.1% OR, odds ratio. Model 1, base model + cytology; model 2, base model + ImmunoCyt; model 3, base model + ImmunoCyt + cytology. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e496 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Cha New York, NY More articles by this author Lenuta-Ancuta Tirsar Furth, Germany More articles by this author Shahrokh Shariat New York, NY More articles by this author Douglas Scherr New York, NY More articles by this author Christian Schwentner Tuebingen, Germany More articles by this author Joerg Hennenlotter Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Christine Mian Bolzano, Italy More articles by this author Paul Christos New York, NY More articles by this author Madhu Mazumdar New York, NY More articles by this author Michele Lodde Bolzano, Italy More articles by this author Armin Pycha Bolzano, Italy More articles by this author Bernd Schmitz-Drager Furth, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...