Urine Test Detects Upper Tract TCC

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It has a high sensitivity and specificity for predicting the cancer's presence, researcher says.

With upper tract transitional cell carcinoma (UTTCC), vigilance is the watchword. Detecting this cancer earlier may directly impact patient survival.

According to the American Cancer Society, 54,390 new cases and 14,100 deaths in the United States will occur during 2008. Up to 15% of all kidney cancers are UTTCC. NMP22 BladderChek Test (Matritech) is approved by the FDA in the detection of bladder cancer.

We investigated the ability of the BladderChek test to detect UTTCC. From January 2005 to September 2007, we performed urinary NMP22 BladderChek Test determinations on 260 consecutive patients referred to our practice for enhancing renal tumors.

Urine NMP22s were obtained on all patients with enhancing solid or complex cystic, or renal pelvic masses or other solid or inflammatory renal lesions considered for surgery. Patients with a co-existing or prior diagnosis of bladder urothelial carcinoma or inflammatory lesions (xanthogranulomatous pyelonephritis, emphysematous pyelonephritis) were excluded from analysis. This patient population was predominantly white males and smokers. The average age was 67 years.

Forty-one patients were diagnosed with urothelial tumors. The NMP22 test had a high sensitivity (78%) and specificity (88.3%) and negative predictive value for the presence of UTTCC. NMP22 test positivity also showed great potential as an adjunct to other risk factors for UTTCC, such as age 60 years and older and smoking history, which are associated with NMP22 positivity.

In the absence of lower-tract disease and the presence of a radiographic renal lesion with a positive NMP22 test, the high specificity should increase clinical suspicion for presence of UTTCC and thus spur further appropriate evaluation. Conversely, negative NMP22 in the presence of a renal lesion may also be a useful tool to rule out presence of UTTCC because of the test's high sensitivity and negative predictive value.

For additional information, contact Dr. Derweesh at iderweesh@ucsd.edu. (Moores UCSD Comprehensive Cancer Center, San Diego).

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