NMP22 test - bladder cancer

http://www.forbes.com/lifestyle/health/feeds/hscout/2006/01/17/hscout530407.html

New Test Spots More Recurrences of Bladder Cancer


TUESDAY, Jan. 17 (HealthDay News) -- A new study further validates the use
of a simple, in-office test to catch recurrences of bladder cancer.

The test, which measures a urinary protein called NMP22, is already
approved by the U.S. Food and Drug Administration and is used in
conjunction with another test called cystoscopy.

"This is real evidence that there is a benefit to using NMP22 plus
cystoscopy," said Dr. Michael A. Palese, director of minimally invasive
urology at Mount Sinai Medical Center in New York City. "This study should
help the test gain more widespread use, in combination with cystoscopy."

"This is the first major publication of this test used in this setting,"
added study author Dr. H. Barton Grossman, deputy chairman of the
department of urology at M.D. Anderson Cancer Center in Houston. "This
test performs pretty well, it's cost-effective, and the results are
available on short order. It's good for physicians to be aware of the
information to see if they want to use it."

The study appears in the Jan. 18 issue of the Journal of the American
Medical Association.

Bladder cancer is the fifth most common type of cancer in the United
States and also has high recurrence rates, ranging from 50 percent to 90
percent, the study noted. Because individuals who have had bladder cancer
need to be followed for the rest of their lives, the expense of the
disease from diagnosis to death is the highest of all cancers in this
country, ranging from $96,000 to $187,000 per patient.

"Overall rates of recurrence in bladder cancer are at least 50 percent,
one out of two," Grossman said. "It doesn't mean it's necessarily going to
be fatal or life-threatening, but it's important to detect it reasonably
early so it can be treated. If it's not picked up early, it has the
potential to turn into a life-threatening disease."

Currently, different tests are used to check for recurrences. Cystoscopy,
a visual inspection of the bladder with a medical instrument usually done
in the doctor's office, can miss some cancers. It is often used with
cytologic analysis, or analysis of cells voided in the urine, but this is
also not perfect. NMP22 is a protein produced in higher concentrations by
malignant cells.

The current study was a fairly large one, involving 668 patients at 23
different practice centers. All participants had a history of bladder
cancer. The actual tests used were provided by Matritech Inc., the
manufacturer.

Cystoscopy on its own identified 91.3 percent of the cancers. When the
NMP22 test was added, 99 percent of the cancers were picked up. The NMP22
test found eight out of nine cancers that were not picked up during the
initial cystoscopy, including seven that were high-grade.

The NMP22 test has the advantages of being simple, easy and
cost-effective.

"It's easier in that you can do it in a physician's office," Palese said.
"We use a dipstick and you can get an answer right away, as opposed to
sending the cytology test to a lab."

In addition, cytology tests are more likely to come back positive when the
cancer is high-grade, and it's more useful to find recurrent bladder
cancer when it's low-grade and can be more easily treated, Palese pointed
out.

The NMP22 test is also used as a screening tool to see if people have
first-time bladder cancer and performs better than cytology, Grossman
added.


http://blcwebcafe.org/dxprocedures.asp
Diagnostic Procedures

Urinalysis / Cytology
Urine cultures often fail to detect malignancy, and cytologic studies can
be of more help as a diagnostic tool. However, these tests are less than
accurate, and due to a rather high rate of false negatives, cannot
exclude the possibility of malignancy. The tests in use are less accurate
in detecting low grade TCC, though a postive result would almost always
indicate a malignancy.

See also urinemarkers for more information about the different types of
tests used in bladder cancer diagnosis, such as NMP22, BTA, FISH and
others.

For a good explanation of urine chemistry:
http://www.nlm.nih.gov/medlineplus/ency/article/003342.htm

Cystoscopy
The cystoscope is inserted into the bladder through the urethra, and
characteristics of the bladder are recorded photographically through a
thin lighted tube, noting any abnormalities and where they are located.
The procedure is considered by patients to be uncomfortable, but bearable.
A flexible cystoscope is used for surveillence, while a a rigid cystoscope
must be used to remove (or biopsy) tissues. Cystoscopy is the most
reliable tool used in diagnosing the presence of tumors.

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