Abstract from Feb. issue of Journal of Urology
<<<EVALUATION OF NMP22 IN THE DETECTION OF TRANSITIONAL CELL CARCINOMA OF
THE BLADDER
DAVID S. STAMPFER,* GENNARO A. CARPINITO, JULIO RODRIGUEZ-VILLANUEVA,
LANCE W. WILLSEY, COLIN P. DINNEY, H. BARTON GROSSMAN, HERBERT A.
FRITSCHE AND W. SCOTT MCDOUGAL
From the Department of Urology, Boston University Medical Center,
Harrison Avenue Campus, and Massachusetts General Hospital, Boston,
Massachusetts, and the Departments of Laboratory Science and Urology,
M.D. Anderson Cancer Center, Houston, Texas
Purpose: Urinary nuclear matrix protein (NMP22) was evaluated for
detection of new and recurrent bladder tumors in patients with a history
of transitional cell carcinoma. Our objective was to determine
sensitivity and specificity of this marker for tumors of various stages
and grades, as well as its use as an adjunct to or substitute for
urinary cytology.
Materials and Methods: A total of 231 patients with a history of
transitional cell carcinoma provided 288 voided urine samples before
cystoscopic examination at 1 of 3 institutions (53 patients were
reevaluated at least once). Urine samples were assayed for NMP22 using
the NMP22 Test Kit.+ Select patients underwent biopsy with appropriate
additional therapy. Voided urinary cytology was obtained in 200 cases.
End points for determination of the absence and presence of tumor were
negative cystoscopy and positive biopsy, respectively. A receiver
operating characteristics curve was constructed to determine the optimal
NMP22 threshold for detection of transitional cell carcinoma. For
positive biopsies NMP22 values were also correlated with tumor stage and
grade. Comparison to cytology was limited to patients with complete
data.
Results: There were 208 negative cystoscopies (158 with cytology) and 66
positive cystoscopies with biopsy (42 with cytology). Of the cases 14
were eliminated from statistical analysis due to incomplete data.
Receiver operating characteristics curve interpretation determined that
6.4 units per ml. was an optimal reference value for detection of
transitional cell carcinoma in this patient group. Sensitivity and
specificity for all pathological groupings was 68 and 80%, respectively.
When compared to cytology the sensitivities of NMP22 and cytology were
67 versus 31 or 40% (depending on the definition of positive cytology).
Conclusions: NMP22 values represented significant improvement over
urinary cytology for detection of transitional cell carcinoma. The
sensitivity of NMP22 for detection of transitional cell carcinoma in
bladder cancer patients was as much as twice that of cytology when a
reference value of 6.4 units per ml. was used. NMP22 analysis was less
costly than cytology and operator independent. While NMP22 has
previously been shown to be a strong predictor of recurrence after tumor
resection, it is an effective and sensitive screening test for detecting
tumors in patients with transitional cell carcinoma. >>> |
