The use of the bladder-tumour associated analyte test to determine the type of cystoscopy in the follow-up of patients with bladder cancer. The United Kingdom and Eire Bladder Tumour Antigen Study Group.

OBJECTIVE

To assess the use of the bladder-tumour associated analyte test (BTA, Bard UK) to determine whether patients with bladder cancer scheduled for cystoscopy under general anaesthesia can have local anaesthesia instead.

PATIENTS AND METHODS

A total of 272 patients who were scheduled for general anaesthesia cystoscopy were entered into a prospective multicentre study. The BTA test was performed on a specimen of freshly voided urine and the type of cystoscopy was determined according to whether the result was positive or negative. Patients with a negative BTA result were examined with the flexible instrument, under local anaesthesia, instead of the planned general anaesthetic cystoscopy.

RESULTS

In 59 patients, the BTA test was positive and tumour was found (true positive), in 145 patients the test was negative and cystoscopy was negative (true negative), in 25 patients the test was positive and cystoscopy was negative (false positive) and in 43 patients, the test was negative but tumour was found on flexible cystoscopy; the patient underwent subsequent cystoscopy under general anaesthesia (false negative). The sensitivity and specificity were 58% and 86% respectively. The use of the BTA test resulted in fewer patients needing cystoscopy under general anaesthesia and saved about 25,500 POUNDS ($31,000) OR 76 POUNDS ($114) PER PATIENT.

CONCLUSION

THE integration of the BTA test into the follow-up of patients with bladder cancer may help to select those suitable for cystoscopy, under a local anaesthetic and this will result in cost savings as well as sparing patients the more invasive procedure. The test is not sufficiently sensitive to replace cystoscopy and there were false-negative results despite high-grade recurrence. Thus, when the test is used as part of a follow-up programme, a timely back-up of cystoscopy under general anaesthesia should be arranged for patients with false-negative results.