Detection of bladder tumours: role of cytology, morphology-based assays, biochemical and molecular markers

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Abstract
Cystoscopy is currently considered the gold standard for the detection of bladder tumours. The role of urine cytology in the initial detection and follow-up of patients is under discussion. Many efforts have been made to increase the detection rates and to predict the outcome of bladder cancer. In this subject review, a series of morphology-based, biochemical and molecular markers were compared with urine cytology for the detection of bladder cancer. Among the various markers reviewed, the average published sensitivity and specificity for the Bard tumour antigen test was 60 and 77%; for the nuclear matrix protein 22 test it was 67 and 72%; for the hyaluronic acid and hyaluronidase test it was 91 and 84%; for the ImmunoCyt it was 90 and 75%; for fluorescence in-situ hybridization it was 85 and 95%; for the telomerase assay it was 77 and 85%; and for the microsatellite assay it was 89 and 100%. DNA ploidy measurements, recent molecular markers and immunoassays designed to detect keratins, proteins, cell adhesion molecules, fibrinogen degradation products, and fibrinolysis markers were also included. As is clear from the brief summary of available assays, the optimal method of application is not yet clear. The integration of an assay into clinical practice takes more than just the documentation of its sensitivity and specificity. However, several of the procedures have received considerable support from urologists as assisting them in the management of their patients.