Diagnostic accuracy of NMP 22 and urine cytology for detection of transitional cell carcinoma urinary bladder taking cystoscopy as gold standard

Abstract

Objective: To determine diagnostic accuracy of NMP 22 and urine cytology in the detection of transitional cell carcinoma (TCC) urinary bladder taking cystoscopy as a gold standard in patients having provisional diagnosis of bladder cancer (BC).
 Methods: This cross sectional validational study enrolled 380 patients fulfilling selection criteria and was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan form July 2018 to July 2019. The urine sample collected underwent NMP22 and cytological analysis followed by rigid cystoscopy. Reports of all three tests divided patients into positive or negative for malignancy as per defined criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of NMP 22, urine cytology and their combination was determined. Receiver operating characteristic (ROC) curve analysis performed and area under the curve (AUC) compared among these tests.
 Results: The average age of patients was 53.08 ± 12.41 years having male to female ratio 3.75:1(300 males and 80 females). NMP 22 had better sensitivity and comparable specificity to cytology (81.9 & 81.2% vs 54 & 93.9%). Combination of NMP 22 / cytology outperformed both in terms of sensitivity (91.63 vs 81.83 vs 53.96), NPV (87.59 vs 77.46 vs 61.02) and diagnostic accuracy (85.26 vs 81.58 vs 71.32) but at the cost of specificity (76.97 vs 81.21 vs 93.94) and PPV (83.83 vs 85.02 vs 92.06). ROC curve revealed statistically significant higher AUC (0.843 vs .815 vs .73) for combination as compared to NMP 22 and Cytology (p<0.001).
 Conclusion: NMP22 is a quick, point of care test having higher sensitivity, NPV and accuracy but similar specificity and PPV to urine cytology for detection of TCC urinary bladder. Combination outperformed both in terms of sensitivity while having modest specificity.
 doi: https://doi.org/10.12669/pjms.36.4.1638
 How to cite this:Sajid MT, Zafar MR, Ahmad H, Saif Ullah, Mirza ZI, Shahzad K. Diagnostic accuracy of NMP 22 and urine cytology for detection of transitional cell carcinoma urinary bladder taking cystoscopy as gold standard. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1638
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Diagnostic performance of nuclear matrix protein 22 and urine cytology for bladder cancer: A meta‐analysis

“…Results of the literature search 397 relevant literatures were retrieved, including 86 English literatures and 311 Chinese literatures. In strict accordance with the inclusion and exclusion criteria, 385 documents that did not meet the requirements such as duplicate documents, reviews, non-clinical research documents, and dissertations were removed, and 12 documents were finally included, [11][12][13][14][15][16][17][18][19][20][21][22] which included 2456 cases of study objects. All tests directly provide or can be calculated to obtain the complete data of the four-diagnosis table, and all evidence such as cystoscopy biopsy or postoperative pathological examination results is used as the gold standard.…”

“…However, some studies have shown that NMP22 had better specificity than sensitivity. For example, the results of both Rhijn, Bwgv et al, and MT Sajid et al, showed that the sensitivity of NMP22 was lower than the specificity, the reason may be related to the different selected thresholds between the studies and the differences in the number of patients 13,14 . In the SF Shariat study, NMP22 predicted bladder cancer with equal sensitivity and specificity at a threshold of 6.5 U/ml, and was preferable to the 10 U/ml cut‐point across all pathological stages and grades 15 …”

“…showed that the sensitivity of NMP22 was lower than the specificity, the reason may be related to the different selected thresholds between the studies and the differences in the number of patients. 13,14 In the SF Shariat study, NMP22 predicted bladder cancer with equal sensitivity and specificity at a threshold of 6.5 U/ml, and was preferable to the 10 U/ml cut-point across all pathological stages and grades. 15 From the results of meta analysis alone, the diagnostic efficiency of NMP22 is not high, and it cannot replace cystoscopy and pathological examination to diagnose and screen bladder tumors alone; but from the perspective of clinical application value, the pre-test probability is set to 58%, and the pre-test probability is set to 58%.…”

Diagnostic Value of Telomerase Activity in Patients With Bladder Cancer: A Meta-Analysis of Diagnostic Test

“…NMP-22 is a quick, point of care test having higher sensitivity. In a diagnostic test that included 380 samples, the sensitivity of NMP-22 was 81.9% but at the cost of specificity of 76.97% ( 37 ). According to a meta-analysis that included 22 studies, the diagnostic accuracy of urine cytokeratin 20 for bladder cancer is improved with the progression of tumor stage and grade ( 38 ).…”

Clinical efficacy of intravesical gemcitabine combined with ubenimex in patients with non-muscle-invasive bladder carcinoma after transurethral resection of bladder tumor

“… 3 At present, for patients without surgical contraindications, cystoscopy and transurethral resection of bladder tumor (TURBT) are still the gold standard for NMIBC treatment because of their minimal invasion, less pain and rapid postoperative recovery. 4 However, NMIBC still has a high risk of recurrence after surgery, and postoperative adjuvant intravesical chemotherapy is needed to eliminate residual tumor cells and reduce the recurrence rate. 5 Currently, there are many drugs used in intravesical chemotherapy, such as mitomycin, pirarubicin and epirubicin, which have no obvious advantage in preventing recurrence compared with another drug.…”