Artikel
Xpert Bladder Cancer Monitor in the follow-up of patients affected by non muscle invasive bladder cancer (nmibc): an update
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Autoren
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Carolina D'Elia
- Krankenhaus Bozen, Urologie
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Emanuela Trenti
- Krankenhaus Bozen, Urologie
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Alexander Pycha
- Luzerner Kantonsspital, Urologie
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Christine Mian
- Krankenhaus Bozen, Pathologie
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Christine Schwienbacher
- Krankenhaus Bozen, Pathologie
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Esther Hanspeter
- Krankenhaus Bozen, Pathologie
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Armin Pycha
- Krankenhaus Bozen, Urologie
| Veröffentlicht: | 8. April 2019 |
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Gliederung
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Introduction and objectives: The Xpert Bladder Cancer Monitor kit is a new urinary marker test based on the evaluation of 5 targets mRNAs (ABL1, CRH, IGF2, UPK1B and ANXA10), overexpressed in patient with BC.
The aim of our study was to further evaluate the diagnostic accuracy of the Xpert BC Monitor test in the follow up of patients with history of NMIBC and to compare it with urinary cytology, cystoscopy and/or histology.
Materials and methods: 307 patients under follow up for NMIBC were included in this prospective study. Samples were analyzed with the Xpert BC Monitor kit and urinary cytology. Subsequently to urine collection, the patients underwent cystoscopy and if positive a TUR-B.
Cytologies were evaluated according to the Paris System of reporting cytology. The Xpert BC Monitor test was reported by the software as negative or positive (cut-off total LDA=0.5). Sensitivity, specificity, PPV and NPV of Xpert BC Monitor and cytology were calculated using cystoscopy or histology results, if available, as gold standard.
Results: Median age of the patients was 80 years (range 28-95). Patients were followed up for low grade (LG) NMIBC in 195 cases and for high grade (HG) in 112 cases. Two patients had to be excluded due to not diagnostic cytology and Xpert BC Monitor. Of the remaining 305 patients, 82 had tumour recurrence (62 LG, 20 HG). Overall sensitivity was 21.9 % (18/82) for cytology, 50% (41/82) for Xpert® BC Monitor and 51.2% (45/82) for the two tests combined. The sensitivity of cytology increased from 4.8% (3/62) in LG to 65% (13/20) in HG tumours whereas, for the Xpert® BC Monitor, the sensitivity was 41.6% (25/62) in LG and 80% (16/20) in HG tumours. Combined, cytology and Xpert® BC Monitor yielded an overall sensitivity of 41.9% (26/62) for LG and 90% (18/20) for HG tumours.
Overall specificity was 99.1% for cytology and 75.7% for Xpert® BC. PPV for cytology was 90% and for Xpert® BC Monitor 43.1% while NPV was similar for the 2 tests: 77.5% for cytology versus 80.5% for Xpert® BC Monitor.
Conclusion: Our data confirm that the sensitivity of the Xpert BC Monitor Test is significantly higher than for cytology as previously reported. The test performs very well in terms of specificity but cannot reach the extremely high value of cytology, PPV is significantly lower than for cytology, while NPV performs approximately the same for both tests.
