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Comparative study of screening techniques used in early detection of urinary bladder cancer


Abstract

Background: Early  detection  of  urinary  bladder  cancer  can  help  improve  patients’ outcomes.  Detection  and  follow-up  for  recurrence  by  cystoscopy  and  histopathology of obtained biopsies is costly and causes discomfort to patients. There is a need to find sensitive,  specific  screening  techniques  as  alternatives  to  reduce  the  frequency  or  to improve the sensitivity for detection of early bladder cancer.

Objective: This study aimed to compare bladder washing cytology (BWC), bladder tumor antigen  (BTA),  flowcytometry  (FCM),  and  photodynamic  diagnosis  (PDD)  for  early detection of urinary bladder cancer.

Methods: This prospective cohort study was conducted on 75 patients with hematuria/cystitis  or  previous  resection  of  bladder  cancer.  The  four  diagnostic  techniques  were performed in every patient. The results of the studied techniques were compared to the histopathological  findings  in  these  patients.  Sensitivity,  specificity,  negative  predictive value (NPV), and positive predictive value (PPV) were calculated.

Results: The BWC and PDD showed the highest accuracy (each was 77.3%). The PPD technique had the highest sensitivity and NPV (91.3% and 94.9%, respectively), while the BWC had the highest specificity and PPV (92.3% and 71.4%, respectively). Sensitivity was higher in high grade tumors than the low grades in BWC, while sensitivity was higher in the low-grade tumors than the high grades in the other techniques.

Conclusions: The BWC and PDD had the highest accuracy for detection of bladder cancer. Their combined use is recommended to obtain high sensitivity and specificity. 

Keywords

bladder wash cytology, bladder tumor antigen, flowcytometry, photodynamic diagnosis, urinary bladder cancer

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