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Kim, Park, Cho, Ham, Lee, Ju, Kwon, and Choi: Comparison of the Efficacy of Urine Cytology, Nuclear Matrix Protein 22 (NMP22), and Fluorescence in Situ Hybridization (FISH) for the Diagnosis of Bladder Cancer
Original Article
Korean Journal of Urology

Korean Journal of Urology 2009; 50(1): 6-11.

Published online: 31 January 2009

DOI: https://doi.org/10.4111/kju.2009.50.1.6

Comparison of the Efficacy of Urine Cytology, Nuclear Matrix Protein 22 (NMP22), and Fluorescence in Situ Hybridization (FISH) for the Diagnosis of Bladder Cancer

Won Tae Kim, Kyeongmee Park2, Nam Hoon Cho1, Won Sik Ham, Jin Sun Lee, Hee Jeong Ju, Yong Uk Kwon3, Young Deuk Choi

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul. Korea.

1Department of Pathology, Yonsei University College of Medicine, Seoul. Korea.

2Department of Pathology, Inje University College of Medicine, Seoul, Korea.

3Department of Urology, College of Medicine, Kwandong University, Goyang, Korea.

youngd74@yuhs.ac

Received 25 June 2008       Accepted 5 November 2008

Copyright © 2009 The Korean Urological Association

Abstract

Purpose

We compared the efficacy of urine cytology, nuclear matrix protein 22 (NMP22), and fluorescence in situ hybridization (FISH) for the detection of bladder cancer.

Materials and Methods

Washing urine samples from 156 patients were evaluated for the detection of bladder cancer. Patients were divided into 3 groups. Group 1 was 106 patients with bladder cancer, group 2 was 30 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate without bladder cancer, and group 3 had gross hematuria without bladder cancer. The sensitivity and specificity of cytology, NMP22, and FISH were compared. NMP22 positivity was defined as ≥10U/ml. FISH was done with the UroVysion® system and FISH positivity was defined as ≥2 abnormal urothelial cells with an abnormal signal from any out of 4 probes.

Results

The overall sensitivity of urine cytology, NMP22, and FISH was 60.4%, 75.5%, and 84.9%, respectively (p<0.001). The overall specificity of cytology, NMP22, and FISH was 96.7%, 83.3%, and 93.3%, respectively (p=0.168). In group 3, the false-positive rates of cytology, NMP22, and FISH were 20.0%, 55.0%, and 10.0%, respectively. In these patients with gross hematuria, the false-positive rate with NMP22 was significantly higher than with cytology or FISH (p=0.004). The sensitivity of cytology, NMP22, and FISH in low-grade bladder cancer patients was 25.9%, 51.9%, and 77.8%, respectively, and that in pTa-1 bladder cancer patients was 40.6%, 65.6%, and 78.1%, respectively. In low-grade or in pTa-1 patients, the sensitivity of the three diagnostic tools was significantly different (low grade; p<0.001, pTa-1; p<0.001).

Conclusions

FISH is more sensitive in low-grade bladder cancer than is urine cytology and can be used as a diagnostic tool for the detection of primary and recurrent bladder cancer. NMP22 was affected by gross hematuria and thus has limitations for screening of bladder cancer. However, it can be used to follow-up bladder cancer.

Keywords: Transitional cell carcinoma, In situ hybridization, fluorescence, Nuclear matrix protein 22

Figures and Tables

Table 1
Overall results of cytology, NMP22, and FISH of each group
kju-50-6-i001

NMP: nuclear matrix protein, FISH: fluorescence in situ hybridization, Group 1: bladder tumor patients group, Group 2: benign prostatic hyperplasia group, Group 3: hematuria or infection group

Table 2
Overall sensitivity, specificity, positive predictive value, and negative predictive value of urine cytology, NMP22, and FISH for the detection of bladder tumors
kju-50-6-i002

NMP: nuclear matrix protein, FISH: fluorescence in situ hybridization, PPV: positive predictive value, NPV: negative predictive value

Table 3
False-positive rates of group 2 and group 3
kju-50-6-i003

NMP: nuclear matrix protein, FISH: fluorescence in situ hybridization

Table 4
Sensitivity of cytology, NMP22, and FISH for the detection of bladder tumors according to grade and stage
kju-50-6-i004

NMP: nuclear matrix protein, FISH: fluorescence in situ hybridization

Table 5
The overall sensitivity, specificity, positive predictive value, and negative predictive value of combination of cytology, NMP22, and FISH for the detection of bladder tumors
kju-50-6-i005

Cyto: cytology, NMP: nuclear matrix protein, FISH: fluorescence in situ hybridization, PPV: positive predictive value, NPV: negative predictive value

Table 6
Sensitivity of combination of cytology, NMP22, and FISH for the detection of bladder tumors according to grade and stage
kju-50-6-i006

Cyto: cytology, NMP: nuclear matrix protein, FISH: fluorescence in situ hybridization

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