Comparison of the sensitivity and specificity of urine cytology, urinary nuclear matrix protein-22 and multitarget fluorescence in situ hybridization assay in the detection of bladder cancer

Abstract

Objective. This study aimed to compare the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of urine cytology, BladderChek nuclear matrix protein-22 (NMP22) and UroVysion^™ fluorescence in situ hybridization (FISH) tests in patients with newly diagnosed bladder cancer, those with recurrent bladder cancer, and those with bladder cancer but in remission during surveillance. Material and methods. Voided urine samples obtained from 178 patients with suspected or known bladder cancer about to undergo diagnostic or surveillance cystoscopy and 25 control subjects without the disease were divided into four and used for urine culture and cytology, NMP22 BladderChek and UroVysion FISH tests. The sensitivity, specificity, PPV and NPV for each test were calculated. Comparison was made between the ability of each test to detect bladder cancer in the three category of patients listed. Results. Of the 178 patients with bladder cancer, 43 were newly diagnosed, 58 had recurrent disease and 77 were in remission. The sensitivity of each test in newly diagnosed patients was: urine cytology 28%, NMP22 88% and FISH 80%; and in patients with recurrent disease: urine cytology 33%, NMP22 57% and FISH 85%. The mean specificity for urine cytology, NMP22 and FISH was 95%, 67% and 48%, respectively. Conclusion. Of the tests used in the study for detection of bladder cancer, NMP22 appeared to be most cost-effective and rapid, with relatively high sensitivity and specificity in all categories of patients. The NMP22 test may be considered a new gold standard for the assessment of patients with known or suspected bladder cancer.

Key Words::

• Bladder cancer
• diagnosis
• NMP22
• urine cytology
• UroVysion FISH

Acknowledgements

This work was supported by Kuwait University research grant MS 02/03. The following technical staff assisted with this project: Mrs Vinsu Jerin and Ms Sarah Jeena John assisted with the reading of NMP22 BladderChek test and Mrs Sindhu Jacob carried out the UroVysion FISH assay under the supervision of F.A. Dr Anjum Memon of the Department of Primary Care, University of Sussex, UK, provided the statistical review. This work also used some resources (mostly the FISH software program) at the Research Core Facility of the Health Sciences Center of Kuwait University, Kuwait (grant nos GM01/01 and GM01/05).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.