Utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria

Nakamura, Kogenta; Iczkowski, Kenneth A.; Chang, Myron; Pendleton, John; Anai, Satoshi; Rosser, Charles J.

doi:10.1186/1471-2490-9-12

Cited by 33 publications

(33 citation statements)

References 18 publications

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“…Although the urine cytology has a high overall specificity (98.8%) at the end point of surveillance, it has low overall sensitivity in detecting urothelial cancer (46.4%), In other words, 2 bladder urothelial carcinomas out of 172 patients might have been missed using voided urine cytology alone., These results are in concurrence with other reports [14][15][16]. Also, Rosser and colleagues confirm the low sensitivity of urinary cytology at 33% (88% if atypia is considered positive) and the high specificity of urine cytology ranging from 67% (47/47+23) if atypia is considered positive to 100% (if atypia if considered negative) [17]. However, none of the 180 patients with negative voided urine cytology revealed evidence of bladder urothelial carcinoma with follow-up cystoscopy 6 months after initial diagnosis.…”

Section: Percent (Number Of Cases/total Number) Voided Urine Cytologysupporting

confidence: 79%

The Role of Cytologic Analysis in Follow-Up of Non-Muscle Invaisve Urothelial Cell Carcinoma in Relation to Cystoscopic Biopsy

Badary¹,

Reda²

2017

J Mol Biomark Diagn

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Background: Bladder urothelial carcinoma has high recurrence rate so patients with bladder urothelial carcinoma have to be monitored thoroughly for disease recurrence, this makes bladder cancer one of the most expensive cancer types for the health care system. Voided urine cytology is the most commonly used noninvasive follow-up diagnostic tool. The purpose of this study was to assess the role of voided urine cytology for the follow-up of patients with non-muscle invasive urothelial carcinoma (NMIUC).

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Section: Percent (Number Of Cases/total Number) Voided Urine Cytologysupporting

confidence: 79%

The Role of Cytologic Analysis in Follow-Up of Non-Muscle Invaisve Urothelial Cell Carcinoma in Relation to Cystoscopic Biopsy

Badary¹,

Reda²

2017

J Mol Biomark Diagn

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“…Complicating matters further, cystoscopy has been associated with significant patient anxiety [32] and loss in adherence to strict follow-up set forth by current guidelines [33]. Accordingly, VUC (the microscopic evaluation of shed cancer cells in voided urine) is routinely used as a non-invasive adjunct test to cystoscopy, but the major limitation of this evaluation centers on the reported low sensitivity, particularly for the detection of low-grade, low stage tumors (~20–40%) [34, 35]. Coupled with the fact that VUC is also prone to considerable inter-observer variation [36], it is understandable that this method has not emerged as a standalone test for the detection of BCa.…”

Section: Discussionmentioning

confidence: 99%

External Validation of a Multiplex Urinary Protein Panel for the Detection of Bladder Cancer in a Multicenter Cohort

Chen

Chang

Dai

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Due to the faltering sensitivity and/or specificity, urine-based assays currently have a limited role in the management of patients with bladder cancer (BCa). The aim of this study was to externally validate our previously reported protein biomarker panel from multiple sites in the US and Europe. Methods This multicenter external validation study included a total of 320 subjects (BCa = 183). The 10 biomarkers (IL8, MMP9, MMP10, SERPINA1, VEGFA, ANG, CA9, APOE, SDC1 and SERPINE1) were measured using commercial ELISA assays in an external laboratory. The diagnostic performance of the biomarker panel was assessed using receiver operator curves (ROC) and descriptive statistical values. Results Utilizing the combination of all 10 biomarkers, the AUROC for the diagnostic panel was noted to be 0.847 [95% CI: 0.796 – 0.899], outperforming any single biomarker. The multiplex assay at optimal cutoff value achieved an overall sensitivity of 0.79, specificity of 0.79, PPV of 0.73 and NPV of 0.84 for BCa classification. Sensitivity values of the diagnostic panel for high-grade BCa, low-grade BCa, MIBC and NMIBC were 0.81, 0.90, 0.95 and 0.77, respectively. Conclusions Urinary levels of the biomarker panel enabled discrimination of BCa patients and controls, and the levels of biomarker subsets were associated with advancing tumor grade and stage. Impact If proven to be reliable, urinary diagnostic biomarker assays can detect BCa in a timely manner such that the patient can expect improvements in overall survival and quality of life.

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“…2) The sensitivity of urinary cytology in our cohort with predominantly high grade disease was lower than would perhaps be expected but in line with our previous experiences with cytology, which had high variability of interpretation among observers as well as poor sensitivity. 30 In subsequent studies we could use multiple cytopathologists to better control the interpretive variability of cytology but comparison with the actual recorded clinical evaluation is most appropriate. 3) Urine samples were retrieved from a frozen tissue bank.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Potential of Urinary α1-Antitrypsin and Apolipoprotein E in the Detection of Bladder Cancer

Urquidi¹,

Goodison²,

Ross³

et al. 2012

Journal of Urology

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Purpose The ability to reliably diagnose bladder cancer in voided urine samples would be a major advance. Using high throughput technologies, we identified a panel of bladder cancer associated biomarkers with potential clinical usefulness. In this study we tested 4 potential biomarkers for the noninvasive detection of bladder cancer. Materials and Methods We examined voided urine specimens from 124 patients, including 63 newly diagnosed with bladder cancer and 61 controls. Concentrations of proteins were assessed by enzyme-linked immunosorbent assay, including α1-antitrypsin, apolipoprotein E, osteopontin and pentraxin 3. Data were compared to the results of urinary cytology and the BTA Trak® enzyme-linked immunosorbent assay based bladder cancer detection assay. We used the AUC of ROC curves to compare the usefulness of each biomarker to detect bladder cancer. Results Urinary levels of α1-antitrypsin, apolipoprotein E and bladder tumor antigen were significantly increased in subjects with bladder cancer. α1-Antitrypsin (AUC 0.9087, 95% CI 0.8555–0.9619) and apolipoprotein E (AUC 0.8987, 95% CI 0.8449–0.9525) were the most accurate biomarkers. The combination of α1-antitrypsin and apolipoprotein E (AUC 0.9399) achieved 91% sensitivity, 89% specificity, and a positive and negative predictive value of 89% and 90%, respectively. Multivariate regression analysis highlighted only apolipoprotein E as an independent predictor of bladder cancer (OR 24.9, 95% CI 4.22–146.7, p = 0.0004). Conclusions Alone or in combination, α1-antitrypsin and apolipoprotein E show promise for the noninvasive detection of bladder cancer (OR 24.9, 95% CI 4.22– 146.7, p = 0.0004). Larger, prospective studies including more low grade, low stage tumors are needed to confirm these results.

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Utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria

Abstract: Background: We determine the utility of serial urinary cytologies in patients presenting with microscopic hematuria who were evaluated with upper and lower urinary tract studies to rule out a malignancy.

Cited by 33 publications

References 18 publications

The Role of Cytologic Analysis in Follow-Up of Non-Muscle Invaisve Urothelial Cell Carcinoma in Relation to Cystoscopic Biopsy

The Role of Cytologic Analysis in Follow-Up of Non-Muscle Invaisve Urothelial Cell Carcinoma in Relation to Cystoscopic Biopsy

External Validation of a Multiplex Urinary Protein Panel for the Detection of Bladder Cancer in a Multicenter Cohort

Diagnostic Potential of Urinary α1-Antitrypsin and Apolipoprotein E in the Detection of Bladder Cancer

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