UROLOGICAL ONCOLOGY

Newly diagnosed bladder cancer: the relationship of initial symptoms, degree of microhematuria and tumor marker status
Boman H, Hedelin H, Jacobsson S, Holmäng S
From the Department of Surgery, Alingsas Lasarett, Department of Urology, Kärnsjukhuset, Skövde, and Departments of Clinical Chemistry and Transfusion Medicine and Urology, Sahlgrenska University Hospital, Göteborg, Sweden
J Urol. 2002; 168:1955-9

• Purpose: We recorded initial symptoms and evaluated the frequency and intensity of hematuria in patients with newly diagnosed bladder cancer. We also evaluated and compared the sensitivity of bladder wash cytology, NMP22 (Matritech, Newton, Massachusetts), BTA Stat (Bion Diagnostic Sciences, Redmond, Washington) and UBC antigen (IDL Biotech, Sollentona, Sweden) with hematuria dipsticks and flow cytometry for determining the size of erythrocytes in urine.
• Materials and Methods: Urine samples were collected from 92 patients with newly diagnosed bladder cancer, 64 with idiopathic microhematuria and 42 with nephritis. Urine was analyzed for NMP22, BTA Stat, UBC and erythrocytes size using flow cytometry. Bladder wash cytology was done at cystoscopy. Urine was analyzed for microhematuria with hematuria dipsticks at home for 7 consecutive days immediately before the operation and in the hospital on the day of surgery.
• Results: Sensitivity was 75% for NMP22, 78% for BTA Stat, 64% for UBC and 61% for flow cytometry at 73% specificity. Cytology had 42% sensitivity at 97% specificity. Tumor size, grade and stage had a statistically significant influence on NMP22, BTA Stat, UBC and cytology. Of the patients 75% had microhematuria on the day of the operation and 75% had hematuria at least 1 of 7 days when tested at home the last week before transurethral bladder resection. The 70% of all patients with macroscopic hematuria as the initial symptom did not seem to differ from those without the condition in tumor size, grade, stage or tumor marker levels.
• Conclusions: Flow cytometry was not well enough able to distinguish patients with bladder cancer from controls. The sensitivity of all tested markers, including hematuria dipsticks, was high for large and high grade, high stage tumors. Further studies are needed to evaluate whether a marker could be used to determine priority among patients referred due to microhematuria.
  
  
• Editorial Comment
  Non-invasive diagnosis of superficial bladder cancer is still an important issue in urology. These authors recorded the initial symptoms of patients with newly diagnosed bladder cancer, and compared different noninvasive methods (cytology, NMP 22, BTA Stat, UBC-Antigen, hematuria dipsticks, and flow cytometry) in 92 patients with bladder cancer and others with nonmalignant disease. As with all other recent prospective trials incorporating this diagnostic tool, cytology had a low sensitivity (42%), albeit, at a high specificity (97%). The overall sensitivity of the other noninvasive tests was unsatisfying 7%. The paper gives the detailed insight into subgroups specificity, relationship of grade and stage to marker sensitivity, and other interesting details. In conclusion, the results of this prospective analysis would not convince the responsible urologist to abandon the golden standard of cystoscopy if bladder cancer is suspected.

Dr. Andreas Böhle
Professor and Vice-Director of Urology
Medical University of Luebeck
Luebeck, Germany