• To employ decision curve analysis to determine the impact of nuclear matrix protein 22 (NMP22) on clinical decision making in the detection of bladder cancer using data from a prospective trial.
• The study included 1303 patients at risk for bladder cancer who underwent cystoscopy, urine cytology and measurement of urinary NMP22 levels. • We constructed several prediction models to estimate risk of bladder cancer. The base model was generated using patient characteristics (age, gender, race, smoking and haematuria); cytology and NMP22 were added to the base model to determine effects on predictive accuracy. • Clinical net benefit was calculated by summing the benefits and subtracting the harms and weighting these by the threshold probability at which a patient or clinician would opt for cystoscopy.
• In all, 72 patients were found to have bladder cancer (5.5%). In univariate analyses, NMP22 was the strongest predictor of bladder cancer presence (predictive accuracy 71.3%), followed by age (67.5%) and cytology (64.3%). • In multivariable prediction models, NMP22 improved the predictive accuracy of the base model by 8.2% (area under the curve 70.2-78.4%) and of the base model plus cytology by 4.2% (area under the curve 75.9-80.1%). • Decision curve analysis revealed that adding NMP22 to other models increased clinical benefit, particularly at higher threshold probabilities.
• NMP22 is a strong, independent predictor of bladder cancer. • Addition of NMP22 improves the accuracy of standard predictors by a statistically and clinically significant margin. • Decision curve analysis suggests that integration of NMP22 into clinical decision making helps avoid unnecessary cystoscopies, with minimal increased risk of missing a cancer.
[Show abstract][Hide abstract] ABSTRACT: Introduction. Several point-of-care tests (POCT) are available for the diagnosis of bladder cancer (BC). We evaluate the impact of HU (hematuria) on performance of POCTs. Materials and Methods. Urine from 10 donors was diluted with blood from 0.5 to 0.00625%. BladderCheckR, BTAstatR, BCMR, and BTAR tests were applied. Tests were additionally conducted in 54 patients with HU. HU was stratified according to the amount of erythrocytes (RBC)/μL using two systems: (1) no HU; mild microscopic HU; severe microscopic HU; gross HU; (2) I <25 RBCs; <250
III. Results were compared to HU status and histopathology.
Results. Gross HU became evident between 2090 RBCs/μL and 1065/μL. Addition of blood led to default tests in all 4: BladderCheckR 0.25%; BCM 0.025%, BioNexia 0.00625%, and BTAstat <0.00625%. Rates of false positives for BladderCheck, BTAstat, BCM, and BioNexia were 5.9, 11.8, 0, and 1.8% without HU and 0, 66.7, 44.4, and 66.7% with HU. BTAstat, BCM, and BioNexia were independently influenced by HU (P < 0.0002).
Conclusions. NMP22-BladderCheck was most resistant to blood. The diagnostic yield of all others was significantly influenced by HU. A well-defined HU grading helps to define limits of HU for a reliable interpretation of BC-POCTs.
Advances in Urology 11/2011; 2011:937561. DOI:10.1155/2011/937561
[Show abstract][Hide abstract] ABSTRACT: Bladder cancer diagnosis and patient surveillance present a wide range of diagnostic methods but essentially only instrumental approaches are available in the clinical setting. Although numerous new noninvasive biomarkers have been proposed in the last 10 years, few are US FDA-approved for clinical purposes, and none are widely used in routine clinical practice. In this review, we summarize the tests developed for early diagnosis and patient surveillance and verify whether, for any, there is some level of evidence to suggest a real usefulness in a clinical setting.
[Show abstract][Hide abstract] ABSTRACT: The prognosis of patients with high-risk bladder cancer is generally poor. In addition to advanced stage and high-grade tumors, several histopathological subtypes of invasive bladder cancer have been identified as being more aggressive than conventional forms. However, modalities for early detection of such aggressive neoplasms are limited. This review examines the pathological features of aggressive bladder cancer and critically reviews the performance of selected methodologies that are commonly used to detect such lesions.
Strategies including bladder tumor antigen assay, NMP22, ImmunoCyt, and UroVysion hold promise for the early detection of aggressive urothelial carcinomas of the bladder. However, such approaches are currently limited by their sensitivity and potential for false-positive results, and are unlikely to substitute cystoscopy.
Molecular-based detection techniques represent potentially attractive strategies for noninvasive detection of aggressive bladder cancer using urine as the specimen source. Identification of new markers and development of novel platforms may improve detection in the future.
Current opinion in urology 07/2012; 22(5):397-404. DOI:10.1097/MOU.0b013e328356ade6 · 2.33 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.