Authors: Nur Budaya Taufiq.
Introduction: Bladder malignancy is a common urologic malignancy. Pathologic examination obtained by biopsy through cystoscopy is the gold standard for diagnosing, but this is invasive. The use of NMP22, cytokeratin-18 and CA 19-9 and as a marker in urine for bladder malignancy had been studied and had high sensitivity but expensive, otherwise, cytology for marker bladder malignancy is noninvasive, cheaper but had less sensitivity. This study to determine the sensitivity and specificity of the four current alternatives to diagnosis bladder malignancy.
Methods: Evaluation of the four current alternatives to bladder malignancy diagnosis was conducted from two urology centers in East Java, Soetomo Hospital Surabaya, and Saiful Anwar Hospital Malang. We evaluated 392 voided urinary specimens of patients with suspicion of bladder malignancy (patients with painless intermittent gross haematuria). All voided urine samples were evaluated by the NMP22, cytokeratin-18, CA 19-9 and cytology. The diagnostic value (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the four examination methods were evaluated according to correlation with cystoscopic findings and histological findings.
Results: In total, 203 patients had histologically proven transitional cell carcinoma of the bladder. There is no significant difference in the stadium. Sensitivity, specificity, PPV and NPV for NMP22 were 90, 6 %, 77, 4%, 78%, and 90%. Sensitivity, specificity, PPV and NPV for cytokeratin-18 were 94%, 75%, 68%, and 95%. Sensitivity, specificity, PPV and NPV for CA 19-9 were 85%, 77, 8%, 81%, and 82% Sensitivity, specificity, PPV and NPV for cytology were 63%, 88%, 83% and 72%
Conclusion: Urine cytokeratin-18 had highest sensitivity for diagnosing bladder malignancy, but urine cytology had highest specificity.
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