Comparative evaluation of urinary bladder cancer antigen and urine cytology in the diagnosis of bladder cancer.

The diagnostic value of the urinary bladder cancer (UBC) antigen as a tumor marker is not clear yet. We designed this study to compare the accuracy of the UBC antigen and voided urine cytology in patients with bladder cancer.MATERIALS AND METHODSFifty-four consecutive patients admitted for a diagnostic workup for bladder cancer were enrolled. Two separate morning midstream voided urine samples were taken for urinalysis, both before performing cystoscopy. The samples were examined for urinary creatinine level, urine cytology, and UBC. Cystoscopy was performed. Resection was performed in the presence of an apparent pathologic lesion, and if no lesion were seen, random biopsies of multiple foci of the bladder were taken. The results of the diagnostic tests were compared with the pathology examination results.RESULTSOf 54 patients, 31 had histologically confirmed transitional cell carcinoma. Results were positive for UBC in 28 and for urine cytology in 16 patients. Sensitivities and specificities were 74.2% and 78.3% for UBC, 48.4% and 95.7% for urine cytology, and 87.1% and 73.9% for combined UBC and cytology, respectively. Positive and negative likelihood ratios were 3.42 and 3.03 for UBC, 11.3 and 1.85 for urine cytology, and 3.34 and 5.73 for combined UBC and cytology, respectively.CONCLUSIONThe UBC test had acceptable sensitivity and specificity in our study. However, results of voided urine cytology are significantly more reliable. A combination of tumor markers may help diagnose new tumors and lower the requirements for cystoscopy during follow-up. Further studies are warranted to find a more accurate noninvasive test or a complex of tests comparable with cystoscopy for diagnosis of bladder cancer.