THE EFFICACY OF BTA TESTING IN AND URINE CYTOLOGY IN SUPERFICIAL BLADDER TUMOR SURVEILLANCE

Objective: The aim of this study was to evaluate place of or on conjunction to cystoscopy. Materials and Method: A cohort of 60 patients with previously proven transitional cell carcinoma of the bladder and in surveillance protocol were recruited for the study. The patients were exclusively chosen from three different subsets; those who had intravesical BCG instillations and those who had epirubisin treatment after the inital TUR-BT. A BTA test was performed prior to the control cystoscopy and both voided urine and bladder washout cytologies were obtained simultaneously. The sensitivities of the BTA test, voided urine and bladder washout cytologies were compared. McNemar and Fisher's variable analysis tests were utilized for statistical analysis. Results: A total of 11 recurrences were encountered. The BTA test was able to detect 10, the bladder washout cytology 9 and the voided urine cytology 5 of them. Both the bladder washout cytology and the BTA test had high sensitivities (81.9% amd 90.9% respectively), but the bladder washout cytology had a low specifity of 46.9% compared to a 75.5% specifity of the BTA test. In terms of the diagnostic value of the tests, there were statistically significant differences between the BTA test and both of the cytological methods (for BTA test and the voided urine cytology p value <0.001, for BTA test and the bladder washout cytology p value <0.01). When the two cytological methods are compared, the bladder washout cytology has a higher sensitivity then the voided urine cytology in follow-up. The efficacy of all three tests were evaluated in the three subgroups and were consistent in themselves and there were no statistical difference of any of the tests in those patients who received intravesical therapy or not. Conclusion: Cytoscopy is still the mainstay for surveillance of the superficial bladder tumors and when combined with the BTA test, the diagnostic efficacy will improve.

Keywords: bladder neoplasms, surveillance, bladder tumor antigen