Patients with a negative cystoscopy and negative NMP22® BladderChek® test are at low risk of missed transitional cell carcinoma of the bladder: A prospective evaluation

John D. Terrell, Keren J. Elias, Arthur I Sagalowsky, Yair Lotan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Urine based tumor markers have uncertain utility in diagnosis or surveillance of patients with bladder cancer while cytology is commonly used. We evaluated whether cytology provides additional diagnostic information in patients with a negative NMP22® BladderChek® test (BladderChek) and negative cystoscopy. Materials and Methods: We performed subset analyses of 2 large prospective multi-center databases evaluating BladderChek for UCB detection and surveillance. These cohorts were analyzed for presence of cancer and result of urine cytology in setting of a negative cystoscopy and negative BladderChek. Subsequently, we prospectively performed cystoscopy, cytology and BladderChek on 434 patients at our institution being evaluated for UCB. Results: In the detection database (n = 1331), 1065 patients had a negative cystoscopy and BladderChek. There were 3 cancers (stages Ta, Tis and T1) and cytology was atypical in one and reactive in two. In the surveillance cohort (n = 668) patients, 437 patients had negative cystoscopy and BladderChek. Cancer was found in 2 patients (stages Tis and Ta). The patient with Tis has dysplastic cytology and Ta tumor had reactive cytology. In our cohort of 434 patients, 288 pts had negative cystoscopy and BladderChek. One cancer was missed, a Ta ureteral urothelial carcinoma with a reactive cytology. Conclusions: In patients with negative cystoscopy and BladderChek, very few cancers are missed and cytology was not effective in detection. Use of a point-of-care test in conjunction with cystoscopy in lieu of cytology could decrease cost, provide immediate results, improve negative predictive value and reduce the uncertainty that results from inconclusive cytologic results.

Original languageEnglish (US)
Pages (from-to)706-711
Number of pages6
JournalInternational Braz J Urol
Volume37
Issue number6
DOIs
StatePublished - Nov 2011

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Cystoscopy
Transitional Cell Carcinoma
Cell Biology
Urinary Bladder
Neoplasms
Point-of-Care Systems
nuclear matrix protein 22
Urine
Databases
Tumor Biomarkers
Urinary Bladder Neoplasms
Uncertainty
Carcinoma
Costs and Cost Analysis

Keywords

  • Cytology
  • Diagnosis
  • Kidney neoplasms
  • Nuclear matrix protein 22
  • Population surveillance

ASJC Scopus subject areas

  • Urology

Cite this

@article{03642df7831a42b4aa0eab6152d2a776,
title = "Patients with a negative cystoscopy and negative NMP22{\circledR} BladderChek{\circledR} test are at low risk of missed transitional cell carcinoma of the bladder: A prospective evaluation",
abstract = "Objectives: Urine based tumor markers have uncertain utility in diagnosis or surveillance of patients with bladder cancer while cytology is commonly used. We evaluated whether cytology provides additional diagnostic information in patients with a negative NMP22{\circledR} BladderChek{\circledR} test (BladderChek) and negative cystoscopy. Materials and Methods: We performed subset analyses of 2 large prospective multi-center databases evaluating BladderChek for UCB detection and surveillance. These cohorts were analyzed for presence of cancer and result of urine cytology in setting of a negative cystoscopy and negative BladderChek. Subsequently, we prospectively performed cystoscopy, cytology and BladderChek on 434 patients at our institution being evaluated for UCB. Results: In the detection database (n = 1331), 1065 patients had a negative cystoscopy and BladderChek. There were 3 cancers (stages Ta, Tis and T1) and cytology was atypical in one and reactive in two. In the surveillance cohort (n = 668) patients, 437 patients had negative cystoscopy and BladderChek. Cancer was found in 2 patients (stages Tis and Ta). The patient with Tis has dysplastic cytology and Ta tumor had reactive cytology. In our cohort of 434 patients, 288 pts had negative cystoscopy and BladderChek. One cancer was missed, a Ta ureteral urothelial carcinoma with a reactive cytology. Conclusions: In patients with negative cystoscopy and BladderChek, very few cancers are missed and cytology was not effective in detection. Use of a point-of-care test in conjunction with cystoscopy in lieu of cytology could decrease cost, provide immediate results, improve negative predictive value and reduce the uncertainty that results from inconclusive cytologic results.",
keywords = "Cytology, Diagnosis, Kidney neoplasms, Nuclear matrix protein 22, Population surveillance",
author = "Terrell, {John D.} and Elias, {Keren J.} and Sagalowsky, {Arthur I} and Yair Lotan",
year = "2011",
month = "11",
doi = "10.1590/S1677-55382011000600004",
language = "English (US)",
volume = "37",
pages = "706--711",
journal = "International Braz J Urol",
issn = "1677-5538",
publisher = "Brazilian Society of Urology",
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TY - JOUR

T1 - Patients with a negative cystoscopy and negative NMP22® BladderChek® test are at low risk of missed transitional cell carcinoma of the bladder

T2 - A prospective evaluation

AU - Terrell, John D.

AU - Elias, Keren J.

AU - Sagalowsky, Arthur I

AU - Lotan, Yair

PY - 2011/11

Y1 - 2011/11

N2 - Objectives: Urine based tumor markers have uncertain utility in diagnosis or surveillance of patients with bladder cancer while cytology is commonly used. We evaluated whether cytology provides additional diagnostic information in patients with a negative NMP22® BladderChek® test (BladderChek) and negative cystoscopy. Materials and Methods: We performed subset analyses of 2 large prospective multi-center databases evaluating BladderChek for UCB detection and surveillance. These cohorts were analyzed for presence of cancer and result of urine cytology in setting of a negative cystoscopy and negative BladderChek. Subsequently, we prospectively performed cystoscopy, cytology and BladderChek on 434 patients at our institution being evaluated for UCB. Results: In the detection database (n = 1331), 1065 patients had a negative cystoscopy and BladderChek. There were 3 cancers (stages Ta, Tis and T1) and cytology was atypical in one and reactive in two. In the surveillance cohort (n = 668) patients, 437 patients had negative cystoscopy and BladderChek. Cancer was found in 2 patients (stages Tis and Ta). The patient with Tis has dysplastic cytology and Ta tumor had reactive cytology. In our cohort of 434 patients, 288 pts had negative cystoscopy and BladderChek. One cancer was missed, a Ta ureteral urothelial carcinoma with a reactive cytology. Conclusions: In patients with negative cystoscopy and BladderChek, very few cancers are missed and cytology was not effective in detection. Use of a point-of-care test in conjunction with cystoscopy in lieu of cytology could decrease cost, provide immediate results, improve negative predictive value and reduce the uncertainty that results from inconclusive cytologic results.

AB - Objectives: Urine based tumor markers have uncertain utility in diagnosis or surveillance of patients with bladder cancer while cytology is commonly used. We evaluated whether cytology provides additional diagnostic information in patients with a negative NMP22® BladderChek® test (BladderChek) and negative cystoscopy. Materials and Methods: We performed subset analyses of 2 large prospective multi-center databases evaluating BladderChek for UCB detection and surveillance. These cohorts were analyzed for presence of cancer and result of urine cytology in setting of a negative cystoscopy and negative BladderChek. Subsequently, we prospectively performed cystoscopy, cytology and BladderChek on 434 patients at our institution being evaluated for UCB. Results: In the detection database (n = 1331), 1065 patients had a negative cystoscopy and BladderChek. There were 3 cancers (stages Ta, Tis and T1) and cytology was atypical in one and reactive in two. In the surveillance cohort (n = 668) patients, 437 patients had negative cystoscopy and BladderChek. Cancer was found in 2 patients (stages Tis and Ta). The patient with Tis has dysplastic cytology and Ta tumor had reactive cytology. In our cohort of 434 patients, 288 pts had negative cystoscopy and BladderChek. One cancer was missed, a Ta ureteral urothelial carcinoma with a reactive cytology. Conclusions: In patients with negative cystoscopy and BladderChek, very few cancers are missed and cytology was not effective in detection. Use of a point-of-care test in conjunction with cystoscopy in lieu of cytology could decrease cost, provide immediate results, improve negative predictive value and reduce the uncertainty that results from inconclusive cytologic results.

KW - Cytology

KW - Diagnosis

KW - Kidney neoplasms

KW - Nuclear matrix protein 22

KW - Population surveillance

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DO - 10.1590/S1677-55382011000600004

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VL - 37

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JO - International Braz J Urol

JF - International Braz J Urol

SN - 1677-5538

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