Department of Urology, School of Medicine, Acıbadem University, Istanbul, Turkey.
Int Urol Nephrol. 2012 Jun;44(3):793-8. doi: 10.1007/s11255-012-0144-x. Epub 2012 Feb 28.
Two percent of the bladder non-muscle-invasive (NMI) transitional cell carcinomas (TCC) are associated with upper urinary tract (UUT) TCC. We evaluated the role of nuclear matrix protein-22 (NMP-22) (BladderChek) test in the diagnosis of lower urinary tract and UUT-TCC.
From March 2009 to June 2011, 122 patients with bladder NMI-TCC underwent 205 control cystoscopy. A total of 95 (78 men and 17 women, mean age 60.7 years, range, 27-88) patients who were followed regularly with NMP-22 test and with follow-up cystoscopies (145 episodes; min. 1-max. 5) were included in this study. For routine monitoring of the UUT, IVU or CT urography was used once a year for high grades (HG), and once in every other year for low grades (LG). The sensitivity and specificity of NMP-22 were evaluated by ROC curves, and sensitivity, specificity, and positive and negative predictive values were calculated. Chi-square test was used for the differences between the subgroups.
Cystoscopy and NMP-22 results of the patients included in the study revealed the sensitivity (44.4%) of the test was very low and the specificity (98.4%) was quite high (p < 0.001). Among the 10 cystoscopies where NMP-22 was negative, but cystoscopy was positive for tumor, 8 had LG and 2 had HG TCC. NMP-22 was never positive in low-grade tumors, in other words, all of the NMP-22-positive 8 tumors were high grade. On the other hand, in 20% (2/10) of the cases, NMP-22 can be negative although the tumor was high grade. Two (2.1%) HG UUT-TCC were detected in 95 patients. These 2 patients were within the 125 cystoscopies (75 patients) where both NMP-22 and cystoscopy were negative for tumor.
Nuclear matrix protein-22 cannot detect LG TCC. However, it detects overwhelming majority of HG TCC. For this reason, positive NMP-22 test largely indicates HG TCC. NMP-22 is also not reliable in UUT-TCC, even in HG tumors.
2%的膀胱非肌肉浸润性（NMI）移行细胞癌（TCC）与上尿路（UUT）TCC 相关。我们评估核基质蛋白-22（NMP-22）（BladderChek）试验在下尿路和 UUT-TCC 诊断中的作用。
从 2009 年 3 月至 2011 年 6 月，122 例膀胱 NMI-TCC 患者接受了 205 次对照膀胱镜检查。共有 95 例（78 例男性和 17 例女性，平均年龄 60.7 岁，范围 27-88 岁）患者定期接受 NMP-22 检测和膀胱镜检查随访（145 次；最少 1 次-最多 5 次），纳入本研究。对于 UUT 的常规监测，每年对高级别（HG）进行一次静脉肾盂造影或 CT 尿路造影，对低级别（LG）进行一次隔年静脉肾盂造影或 CT 尿路造影。通过 ROC 曲线评估 NMP-22 的敏感性和特异性，并计算敏感性、特异性、阳性和阴性预测值。卡方检验用于亚组间的差异。
研究中纳入的患者的膀胱镜检查和 NMP-22 结果显示，该检测的敏感性（44.4%）非常低，特异性（98.4%）非常高（p<0.001）。在 10 次 NMP-22 阴性但膀胱镜检查发现肿瘤的膀胱镜检查中，8 次为 LG，2 次为 HG TCC。NMP-22 在低级别肿瘤中从未呈阳性，换句话说，所有 8 个 NMP-22 阳性的肿瘤均为高级别。另一方面，在 20%（2/10）的情况下，即使肿瘤为高级别，NMP-22 也可能呈阴性。在 95 例患者中检测到 2 例（2.1%）HG UUT-TCC。这 2 例患者均在 125 次膀胱镜检查（75 例患者）中，NMP-22 和膀胱镜检查均未发现肿瘤。
核基质蛋白-22 不能检测 LG TCC。然而，它检测到绝大多数 HG TCC。因此，阳性 NMP-22 试验在很大程度上表明 HG TCC。NMP-22 在 UUT-TCC 中也不可靠，即使是 HG 肿瘤也是如此。
