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Identification of Patients with Microscopic Hematuria who are at Greater Risk for the Presence of Bladder Tumors Using a Dedicated Questionnaire and Point of Care Urine Test - A Study by the Members of Association of Urooncology, Turkey

  • Turkeri, Levent (Department of Urology, Faculty of Medicine, Marmara University) ;
  • Mangir, Naside (Department of Urology, Faculty of Medicine, Marmara University) ;
  • Gunlusoy, Bulent (Izmir Teaching and Research Hospital) ;
  • Yildirim, Asif (Urology Clinic, Goztepe Teaching and Research Hospital) ;
  • Baltaci, Sumer (Department of Urology, Faculty of Medicine, Ankara University) ;
  • Kaplan, Mustafa (Department of Urology, Faculty of Medicine, Trakya University) ;
  • Bozlu, Murat (Department of Urology, Faculty of Medicine, Mersin University) ;
  • Mungan, Aydin (Department of Urology, Faculty of Medicine, Karaelmas University)
  • Published : 2014.08.15

Abstract

In patients with microscopic hematuria there is a need for better identification of those who are at greater risk of harbouring bladder tumors. The RisikoCheck(C) questionnaire has a strong correlation with the presence of urothelial carcinoma (UC) of the bladder and in combination with other available tests may help identify patients who require detailed clinical investigations due to increased risk of presence of bladder tumors. This study aimed to evaluate the efficacy of RisikoCheck(C) questionnaire together with NMP-22(R) (BladderChek(R)) as a point-of-care urine test in predicting the presence of bladder tumors in patients presenting with microscopic hematuria as the sole finding. In this multi-institutional prospective evaluation of 303 consecutive patients without a history of urothelial carcinoma (UC), RisikoCheck(C) risk group assessment, urinary tract imaging and cystourethroscopy as well as urine cytology and Nuclear Matrix Protein-22 (NMP-22 BladderChek) testing were performed where available. The sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) for the risk adapted approach were calculated. All patients underwent cystoscopy, and tumors were detected in 18 (5.9%). Urine cytology and NMP-22 was positive for malignancy in 9 (3.2%) and 12 (7.5%) of patients, respectively. A total of 43 (14%) patients were in the high risk group according to the RisikoCheck(C) questionnaire. The sensitivity and specificity of the questionnaire in detecting a bladder tumor was 61.5 % and 84.0 % in the high risk group. In patients with either a positive NMP-22 test or high risk category RisikoCheck(C), 23.6% had bladder tumors with a corresponding sensitivity of 54.2% and specificity of 88.6%. If both tests were negative only 3.3% of the patients had bladder tumors. The results of our study suggest that the efficacy of diagnostic evaluation of patients with microscopic hematuria may be further enhanced by combining RisikoCheck(C) questionnaire with NMP-22.

Keywords

References

  1. Arianayagam M, Arianayagam R, Rashid P (2011). Lower urinary tract symptoms-current management in older men. Aust Fam Physician, 40, 758-67.
  2. Budman LI, Kassouf W, Steinberg JR (2008). Biomarkers for detection and surveillance of bladder cancer. Can Urol Assoc J, 2, 212-21.
  3. Chou R, Dana T (2010). Screening adults for bladder cancer: A review of the evidence for the u.S. Preventive services task force. Ann Intern Med, 153, 461-8. https://doi.org/10.7326/0003-4819-153-7-201010050-00009
  4. Davis R, Jones JS, Barocas DA, et al (2012). Diagnosis, evaluation and follow-up of asymptomatic microhematuria (amh) in adults: AUA Guideline. J Urol, 188, 2473-81. https://doi.org/10.1016/j.juro.2012.09.078
  5. Elias K, Svatek RS, Gupta S, Ho R, Lotan Y (2010). High-risk patients with hematuria are not evaluated according to guideline recommendations. Cancer, 116, 2954-9. https://doi.org/10.1002/cncr.25048
  6. Grossfeld GD, Wolf JS, Litwan MS, et al (2001). Asymptomatic microscopic hematuria in adults: Summary of the aua best practice policy recommendations. Am Fam Physician, 63, 1145-54.
  7. Hee T, Shah S, Ann H, et al (2013). Stratifying patients with haematuria into high or low risk groups for bladder cancer: A novel clinical scoring system. Asian Pac J Cancer Prev, 14, 6327-30. https://doi.org/10.7314/APJCP.2013.14.11.6327
  8. Jung H, Gleason JM, Loo RK, et al (2011). Association of hematuria on microscopic urinalysis and risk of urinary tract cancer. J Urol, 185, 1698-703. https://doi.org/10.1016/j.juro.2010.12.093
  9. Khadra MH, Pickard RS, Charlton M, Powell PH, Neal DE (2000). A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. J Urol, 163, 524-7. https://doi.org/10.1016/S0022-5347(05)67916-5
  10. Lokeshwar VB, Habuchi T, Grossman HB, et al (2005). Bladder tumor markers beyond cytology: International consensus panel on bladder tumor markers. Urology, 66, 35-63. https://doi.org/10.1016/j.urology.2005.08.064
  11. Lokeshwar VB, Soloway MS (2001). Current bladder tumor tests: Does their projected utility fulfill clinical necessity? J Urol, 165, 1067-77. https://doi.org/10.1016/S0022-5347(05)66428-2
  12. Lotan Y, Elias K, Svatek RS, et al (2009). Bladder cancer screening in a high risk asymptomatic population using a point of care urine based protein tumor marker. J Urol, 182, 52-7. https://doi.org/10.1016/j.juro.2009.02.142
  13. Ludecke G, Weidner, W. (2006). $Risikocheck{\copyright}$, an internetbased instrument to identify risk populations for bladder cancer: Experiences of 2 years' online risk check in four languages. Eur Urol Supplements, 5, 254.
  14. Moonen PM, Kiemeney LA, Witjes JA (2005). Urinary NMP22 BladderChek test in the diagnosis of superficial bladder cancer. Eur Urol, 48, 951-6 https://doi.org/10.1016/j.eururo.2005.09.002
  15. Ng KL, Htun TH, Dublin N, Ong TA, Razack AH (2012). Assessment and clinical significance of haematuria in Malaysian patients - relevance to early cancer diagnosis. Asian Pac J Cancer Prev, 13, 2515-18. https://doi.org/10.7314/APJCP.2012.13.6.2515
  16. Turkeri L, Tinay I (2008). Advances in the understanding of the early detection of bladder cancer. Eur Urol Review, 3, 28-30.
  17. Turkeri L, Turker P, Gunlusoy B, et al (2008). Multicenter evaluation of a questionnaire-based screening tool in urethelial carcinoma of the bladder. J Urol, 179, 321.

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