NMP-22 AND URINARY CYTOLOGY AS DIAGNOSTIC TOOLS IN CARCINOMA BLADDER: A PROSPECTIVE ANALYSIS
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Keywords
Bladder cancer, NMP-22, urine cytology, cystoscopy, urinary biomarkers, transitional cell carcinoma
Abstract
Bladder cancer is a common urological malignancy with high recurrence rates requiring lifelong surveillance. While cystoscopy remains the gold standard, it is invasive and costly. Voided urine cytology offers high specificity but poor sensitivity, especially in low-grade tumors. Nuclear Matrix Protein 22 (NMP-22) has emerged as a promising noninvasive urinary biomarker for bladder cancer detection and monitoring.
Methods: A prospective study was conducted at Command Hospital, Kolkata, from January 2009 to June 2010, involving 67 patients (23 fresh cases, 44 on follow-up). All patients underwent voided urine cytology, NMP-22 Bladder Chek testing, and cystoscopy, with histopathology serving as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both tests.
Results: Of 67 patients, 41 had bladder carcinoma confirmed by histopathology. NMP-22 demonstrated a sensitivity of 68.29%, specificity of 88.46%, PPV of 90.32%, and NPV of 63.88%. In contrast, voided urine cytology showed a sensitivity of 12.19%, specificity of 100%, PPV of 100%, and NPV of 41.93%. Grade-wise analysis revealed NMP-22 sensitivity of 75% for low-grade and 69.56% for high-grade tumors, whereas cytology detected only 12.5% and 13.04%, respectively. Both tests failed to detect PUNLMP.
Conclusion: NMP-22 is significantly more sensitive than urine cytology, particularly for low-grade tumors, and offers a reliable adjunct to cystoscopy in bladder cancer detection and surveillance. While cytology remains highly specific, its limited sensitivity restricts its standalone use. Larger multicentric studies are warranted to validate NMP-22 as a standard surveillance tool.
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Dr. Arwinder Singh Brar
Classified Specialist (Surgery), 158 Base Hospital, Bagdogra, West Bengal
Dr. Ramandeep kaur
Associate Professor, Department of Physiology, AIMSR, Bathinda, Punjab