Abstract

COMPARISON OF NMP22 URINARY MARKER TEST AND URINE CYTOLOGY IN THE EARLY DETECTION OF RECURRENT TRANSITIONAL CELL CARCINOMA OF URINARY BLADDER

*Dr. Abdul Rahman Abdul Mhdai (F.I.B.M.S. URO), Dr. Omar Khaleel Ibrahim (F.I.B.M.S. URO) and Aiad Abd Alhameed Hassen (F.I.B.M.S. URO)

ABSTRACT

Background: Urinary Bladder Cancer is the second most common cancer treated by urologists. Its incidence is increasing with age and exposure to environmental toxins. Smoking is a known risk factor. the gold standard of diagnosis of bladder cancer non invasively by urine cytology and invasively by cystoscopy with biopsy for histopathological examination. NMP22 is a tumor marker found in urine that had high sensitivity in detecting low grade and early stage urothelial carcinoma. Aim: To assess clinical utility of NMP22 Bladder Check Test and to compare it with voided urine cytology in early detection of recurrent Bladder Cancer. Patients & Methods: A total of 125 patients of follow up cases of Bladder Cancer were enrolled in this study. Urine samples were assayed for the presence of NMP22 using NMP22 Bladder Check Test and Cytology was performed by a cytopathologist. The diagnosis, determined from the Cystoscopic findings and biopsy findings of the suspicious lesion was considered as the gold standard. For positive biopsies, the results of the NMP22 Test and cytology were also correlated with tumor grade and Stage. Results: From 125 patients, a total number of 59 patients who were positive in cystocopy with histopathological examination which represent the gold standard in our study. Mean age of the patients was 63 years for males and 67 years for females. The NMP22 test was positive in 45 cases and cytology in 21 cases. The sensitivity of NMP22 Test in recurrent bladder cases was 83.3% which was significantly greater than that of cytology 39.5%. In non-invasive lesions of Bladder Cancer (Ta,T1), NMP22 Test and Cytology was positive in 92.5% and 44% of cases respectively. In muscle invasive lesions, NMP22 Test and cytology were equal(100%). The sensitivity of the NMP22 test in low grade tumors (GI,GII) was 75%, which was significantly greater than that of cytology 28%, wherease in high grade tumors (GIII) the sensitivity of NMP22 and cytology were nearly equal (90.9%versus 81.8%) respectively. Conclusion: The NMP22 Bladder Check is a new point of care diagnostic test for urinary bladder cancer. The results of our study have shown that the NMP22 can be used as a follow up tool with urine cytology as we detected high sensitivity and specificity of NMP22 in recurrent bladder cases especially effective in low grade disease where the cytology sensitivity is low but at this time NMP22 cannot replace cystoscopy surveillance from patients with history of bladder cancer.

Keywords: NMP22, cell carcinoma of urinary bladder.