Bladder tumour-associated antigen testing for upper tract urothelial tumours

Introduction: A reliable, non-invasive test for the detection of upper tract TCC from voided urine samples (VUs) is not currently available. Cytological or flow cytometry analysis are insufficiently sensitive and standard clinical diagnosis relies upon invasive imaging. The Bnrd bladder tumour analyte (BTA) test is a rapid method for detecting bladder tumour from VUs. This study evaluated the efficacy of the BTA test in the detection of upper tract urothelial tumours from VUs. Patients and methods: VUs were provided by 60 patients: none had undergone bladder instrumentation in the 2 weeks before sampling. Twenty patients (Group 1) provided VUs before surgery for histologically proven renal pelvic or ureteric TCC, and 20 patients (Group 2) with upper tract calculi and 20 patients (Group 3) with microscopic haematuria but no evidence of urological disease also provided VUs. Groups 2 and 3 were age- and sexmatched with Group 1. The mean patient age was 70 years, with a male to female ratio of 1.2. All VUs were analysed using (i) a standard dipstick test for haematuria. (ii) urine cytology and (iii) the BTA test. Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy for each diagnostic test were calculated. The results are given in the table. Sensitivity (%) Specificity (%) PPV NPV Accuracy Method Dipstick 65 25 30 59 13 Cytology 20 75 19 48 48 BTA 80 92 76 93 89 Conclusion: The BTA test has a better diagnostic accuracy than standard non-invasive clinical methods in the detection of upper tract urothelial tumours from voided urine.