Bladder Cancer Antigen BTA stat and Urine Cytology in Bladder Cancer Diagnosis: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Minggen , ZHAO Xiaokun , WU Zhiping , HOU Yi

Department of Urology, Second Xiangya Hospital, Central South University, Changsha 410011, China;

Corresponding author：

Keywords：

Bladder tumor; BTA stat; Urine cytology; Meta-analysis

DOI：

10.7507/1672-2531.20090085

Video：

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Objective 　To systematic review of bladder cancer antigen (BTA) stat and urine cytology (UC) in the diagnosis of bladder cancer.
Methods 　MEDLINE (Jan.1966 to June 2008), EMbase (Jan.1988 to June,2008), Cochrane Library (Issue 1,2008), CMCC (1979 to June, 2008) and CNKI (Jan.1979 to June, 2008) were searched for studies about BTA stat and cytology in the diagnosis of bladder cancer. The search strategy was made according to the Collaborative Review Group search strategy. Quality of included trials wa assessed by quality assessment of diagnostic accuracy studies.Data were extracted by two reviewers using the designed extraction form. The software MetaDiSc1.4 was used to review management and data analysis.
Results 　In total, 71 relevant studies were searched, of which 13 were included and 58 were excluded, with 3 733 patients involved. Heterogeneity (except for threshold effect) was found within these studies. A meta-analysis was performed using random effect model. Pooled accuracy indicators of sensitivity, specificity, positive likelihood ratio (LR) , negative LR and diagnostic odds ratio (dOR) and 95%CI of BTA stat and UC were 0.68 (0.65,0.70), 0.74 (0.72, 0.76), 2.51 (2.04, 3.09), 0.46 (0.38, 0.55), 5.66 (3.87, 8.29) and 0.41 (0.39, 0.44), 0.97 (0.97, 0.98), 12.64 (7.58, 21.08), 0.62 (0.55, 0.71), 22.16 (12.38, 39.66), respectively. The sensitivity of both methods increased as the higher of tumor grade and stage, and the incipient tumor was higher than the recurrence. Area under curve (AUC) of SROC curve of BTA stat and UC were 0.753 5 and 0.711 9, and Q index were 0.696 3 and 0.662 4, respectively.
Conclusions 　The performance of urine BTA stat is moderate in the diagnosis of bladder tumor. It can not replace the traditional urine cytology and diagnose the bladder cancer alone, but which can be an available noninvasive examination and an important adjunct of preoperative detecting and postoperative monitoring of bladder tumor.

Citation： YANG Minggen,ZHAO Xiaokun,WU Zhiping,HOU Yi. Bladder Cancer Antigen BTA stat and Urine Cytology in Bladder Cancer Diagnosis: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2009, 09(4): 458-464. doi: 10.7507/1672-2531.20090085 Copy

1. Donat SM. Evaluation and follow-up strategies for superficial bladder cancer. Urol Clin North Am, 2003, 30(4): 765-776.

2. Dalbagni G, Herr H. Current use and questions concerning intravesical bladder cancer group for superficial bladder cancer. Urol Clin North Am, 2000, 27(1): 137-146.

3. Sarosdy MF, Hudson MA, Ellis WJ, et al. Improved detection of recurrent bladder cancer using the Bard BTA stat Test. Urology, 1997, 50(3): 349-353.

4. Whiting P, Rutjes AWS, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology, 2003, 3: 25.

5. Jadad AR, Moore RA, Carroll D, et a1. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.

6. Wiener HG, Mian C, Haitel A, et al. Can urine bound diagnostic tests replace cystoscopy in the management of bladder cancer? J Urol, 1998, 159(6): 1876-1880.

7. Leyh H, Marberger M, Conort P, et al. Comparison of the BTA stat test with voided urine cytology and bladder wash cytology in the diagnosis and monitoring of bladder cancer. Eur Urol, 1999, 35(1): 52-56.

8. Pode D, Shapiro A, Wald M, et al. Noninvasive detection of bladder cancer with the BTA stat test. J Urol, 1999, 161(2): 443-446.

9. Ramakumar S, Bhuiyan J, Besse JA, et al. Comparison of screening methods in the detection of bladder cancer. J Urol, 1999, 161(2): 388-394.

10. Sharma S, Zippe CD, Pandrangi L, et al. Exclusion criteria enhance the specificity and positive predictive value of NMP22 and BTA stat. J Urol, 1999, 162(1): 53-57.

11. Giannopoulos A, Manousakas T, Mitropoulos D, et al. Comparative evaluation of the BTAstat test, NMP22, and voided urine cytology in the detection of primary and recurrent bladder tumors. Urology, 2000, 55(6): 871-875.

12. Poulakis V, Witzsch U, De Vries R, et al. A comparison of urinary nuclear matrix protein-22 and bladder tumor antigen tests with voided urinary cytology in detecting and following bladder cancer: the prognostic value of false-positive results. BJU Int, 2001, 88(7): 692-701.

13. Raitanen MP, Marttila T, Nurmi M, et al. Human complement factor H related protein test for monitoring bladder cancer. J Urol, 2001, 165(2): 374-377.

14. van Rhijn BW, Lurkin I, Kirkels WJ, et al. Microsatellite analysis– DNA test in urine competes with cystoscopy in follow-up of superficial bladder carcinoma: a phase II trial. Cancer, 2001, 92(4):768-775.

15. Boman H, Hedelin H, Holmang S. Four bladder tumor markershave a disappointingly low sensitivity for small size and low grade recurrence. J Urol, 2002, 167(1): 80-83.

16. 叶敏, 沈海波, 黄云腾, 等. 几种新瘤标对膀胱癌早期诊断价值的比较. 临床泌尿外科杂志, 2004, 19(3): 151-153.

17. 孙羿, 何辉, 马强, 等. 膀胱肿瘤抗原和透明质酸等七项肿瘤标志物在膀胱肿瘤诊断中的应用价值.中华医学杂志, 2005, 85(35): 2507-2512.

18. Sun Y, He DL, Ma Q, et al. Comparison of seven screening methodsin the diagnosis of bladder cancer. Chin Med J (Engl), 2006, 119(21): 1763-1771.

19. Kinders R, Jones T, Root R, et al. Complement factor H or a related protein is a marker for transitional cell cancer of the bladder. ClinCancer Res, 1998, 4(10): 2511-2520.

20. Lokeshwar VB, Schroeder GL, Selzer MG, et al. Bladder tumor markers for monitoring recurrence and screening comparison of hyaluronic acid-hyaluronidase and BTA-Stat tests. Cancer, 2002, 95(1): 61-7221 Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Croat Med J, 2003, 44(5): 639-650.

1. Donat SM. Evaluation and follow-up strategies for superficial bladder cancer. Urol Clin North Am, 2003, 30(4): 765-776.

2. Dalbagni G, Herr H. Current use and questions concerning intravesical bladder cancer group for superficial bladder cancer. Urol Clin North Am, 2000, 27(1): 137-146.

3. Sarosdy MF, Hudson MA, Ellis WJ, et al. Improved detection of recurrent bladder cancer using the Bard BTA stat Test. Urology, 1997, 50(3): 349-353.

4. Whiting P, Rutjes AWS, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology, 2003, 3: 25.

5. Jadad AR, Moore RA, Carroll D, et a1. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.

6. Wiener HG, Mian C, Haitel A, et al. Can urine bound diagnostic tests replace cystoscopy in the management of bladder cancer? J Urol, 1998, 159(6): 1876-1880.

7. Leyh H, Marberger M, Conort P, et al. Comparison of the BTA stat test with voided urine cytology and bladder wash cytology in the diagnosis and monitoring of bladder cancer. Eur Urol, 1999, 35(1): 52-56.

8. Pode D, Shapiro A, Wald M, et al. Noninvasive detection of bladder cancer with the BTA stat test. J Urol, 1999, 161(2): 443-446.

9. Ramakumar S, Bhuiyan J, Besse JA, et al. Comparison of screening methods in the detection of bladder cancer. J Urol, 1999, 161(2): 388-394.

10. Sharma S, Zippe CD, Pandrangi L, et al. Exclusion criteria enhance the specificity and positive predictive value of NMP22 and BTA stat. J Urol, 1999, 162(1): 53-57.

11. Giannopoulos A, Manousakas T, Mitropoulos D, et al. Comparative evaluation of the BTAstat test, NMP22, and voided urine cytology in the detection of primary and recurrent bladder tumors. Urology, 2000, 55(6): 871-875.

12. Poulakis V, Witzsch U, De Vries R, et al. A comparison of urinary nuclear matrix protein-22 and bladder tumor antigen tests with voided urinary cytology in detecting and following bladder cancer: the prognostic value of false-positive results. BJU Int, 2001, 88(7): 692-701.

13. Raitanen MP, Marttila T, Nurmi M, et al. Human complement factor H related protein test for monitoring bladder cancer. J Urol, 2001, 165(2): 374-377.

14. van Rhijn BW, Lurkin I, Kirkels WJ, et al. Microsatellite analysis– DNA test in urine competes with cystoscopy in follow-up of superficial bladder carcinoma: a phase II trial. Cancer, 2001, 92(4):768-775.

15. Boman H, Hedelin H, Holmang S. Four bladder tumor markershave a disappointingly low sensitivity for small size and low grade recurrence. J Urol, 2002, 167(1): 80-83.

16. 叶敏, 沈海波, 黄云腾, 等. 几种新瘤标对膀胱癌早期诊断价值的比较. 临床泌尿外科杂志, 2004, 19(3): 151-153.

17. 孙羿, 何辉, 马强, 等. 膀胱肿瘤抗原和透明质酸等七项肿瘤标志物在膀胱肿瘤诊断中的应用价值.中华医学杂志, 2005, 85(35): 2507-2512.

18. Sun Y, He DL, Ma Q, et al. Comparison of seven screening methodsin the diagnosis of bladder cancer. Chin Med J (Engl), 2006, 119(21): 1763-1771.

19. Kinders R, Jones T, Root R, et al. Complement factor H or a related protein is a marker for transitional cell cancer of the bladder. ClinCancer Res, 1998, 4(10): 2511-2520.

20. Lokeshwar VB, Schroeder GL, Selzer MG, et al. Bladder tumor markers for monitoring recurrence and screening comparison of hyaluronic acid-hyaluronidase and BTA-Stat tests. Cancer, 2002, 95(1): 61-7221 Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Croat Med J, 2003, 44(5): 639-650.

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1.	Donat SM. Evaluation and follow-up strategies for superficial bladder cancer. Urol Clin North Am, 2003, 30(4): 765-776.
2.	Dalbagni G, Herr H. Current use and questions concerning intravesical bladder cancer group for superficial bladder cancer. Urol Clin North Am, 2000, 27(1): 137-146.
3.	Sarosdy MF, Hudson MA, Ellis WJ, et al. Improved detection of recurrent bladder cancer using the Bard BTA stat Test. Urology, 1997, 50(3): 349-353.
4.	Whiting P, Rutjes AWS, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology, 2003, 3: 25.
5.	Jadad AR, Moore RA, Carroll D, et a1. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
6.	Wiener HG, Mian C, Haitel A, et al. Can urine bound diagnostic tests replace cystoscopy in the management of bladder cancer? J Urol, 1998, 159(6): 1876-1880.
7.	Leyh H, Marberger M, Conort P, et al. Comparison of the BTA stat test with voided urine cytology and bladder wash cytology in the diagnosis and monitoring of bladder cancer. Eur Urol, 1999, 35(1): 52-56.
8.	Pode D, Shapiro A, Wald M, et al. Noninvasive detection of bladder cancer with the BTA stat test. J Urol, 1999, 161(2): 443-446.
9.	Ramakumar S, Bhuiyan J, Besse JA, et al. Comparison of screening methods in the detection of bladder cancer. J Urol, 1999, 161(2): 388-394.
10.	Sharma S, Zippe CD, Pandrangi L, et al. Exclusion criteria enhance the specificity and positive predictive value of NMP22 and BTA stat. J Urol, 1999, 162(1): 53-57.
11.	Giannopoulos A, Manousakas T, Mitropoulos D, et al. Comparative evaluation of the BTAstat test, NMP22, and voided urine cytology in the detection of primary and recurrent bladder tumors. Urology, 2000, 55(6): 871-875.
12.	Poulakis V, Witzsch U, De Vries R, et al. A comparison of urinary nuclear matrix protein-22 and bladder tumor antigen tests with voided urinary cytology in detecting and following bladder cancer: the prognostic value of false-positive results. BJU Int, 2001, 88(7): 692-701.
13.	Raitanen MP, Marttila T, Nurmi M, et al. Human complement factor H related protein test for monitoring bladder cancer. J Urol, 2001, 165(2): 374-377.
14.	van Rhijn BW, Lurkin I, Kirkels WJ, et al. Microsatellite analysis– DNA test in urine competes with cystoscopy in follow-up of superficial bladder carcinoma: a phase II trial. Cancer, 2001, 92(4):768-775.
15.	Boman H, Hedelin H, Holmang S. Four bladder tumor markershave a disappointingly low sensitivity for small size and low grade recurrence. J Urol, 2002, 167(1): 80-83.
16.	叶敏, 沈海波, 黄云腾, 等. 几种新瘤标对膀胱癌早期诊断价值的比较. 临床泌尿外科杂志, 2004, 19(3): 151-153.
17.	孙羿, 何辉, 马强, 等. 膀胱肿瘤抗原和透明质酸等七项肿瘤标志物在膀胱肿瘤诊断中的应用价值.中华医学杂志, 2005, 85(35): 2507-2512.
18.	Sun Y, He DL, Ma Q, et al. Comparison of seven screening methodsin the diagnosis of bladder cancer. Chin Med J (Engl), 2006, 119(21): 1763-1771.
19.	Kinders R, Jones T, Root R, et al. Complement factor H or a related protein is a marker for transitional cell cancer of the bladder. ClinCancer Res, 1998, 4(10): 2511-2520.
20.	Lokeshwar VB, Schroeder GL, Selzer MG, et al. Bladder tumor markers for monitoring recurrence and screening comparison of hyaluronic acid-hyaluronidase and BTA-Stat tests. Cancer, 2002, 95(1): 61-7221 Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Croat Med J, 2003, 44(5): 639-650.