The use of the NMP22 BladderChek test for bladder cancer to optimise investigations in a one-stop haematuria clinic

Summary 

Objective

We assessed the value of the NMP22 BladderChek point-of-care (POC) test (Kyowa Hakko UK Ltd., Slough, UK) in a one-stop haematuria clinic to optimise the choice of further investigations.

Patients and methods

Over 34 months from 2005 until 2007, 590 patients presenting to a haematuria clinic were initially assessed with the NMP22 POC test. Patients with a positive NMP22 were counselled and offered further investigation with upper tract imaging and a general anaesthetic cystoscopy without first undergoing flexible cystoscopy (FC). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the NMP22 POC test in this setting were calculated. The financial impact of this policy was assessed.

Results

In total 58 of 590 men were NMP22 positive. Urothelial malignancy was identified in 22 patients and 5 had a non-urothelial malignancy of the genitourinary system. The sensitivity of the NMP22 test in detecting urothelial malignancy in newly presenting patients was 56.4%, specificity 93.5%, PPV 38.0% and NPV 97.0%. Eleven had no abnormality and none have subsequently developed a malignancy. The number of patients requiring FC fell by 10% resulting in significant financial savings.

Conclusion

The NMP22 POC test can be used as the first test in a haematuria clinic to optimise the choice of subsequent investigations resulting in financial savings.

Keywords: Bladder cancer, Cytology, Haematuria, NMP22, Specificity