Editing Bladder Cancer: Diagnosis and Evaluation (section)

== Labs ==

=== Urine cytology ===
* '''<span style="color:#ff0000">Test characteristics</span>'''
**'''<span style="color:#ff0000">HIGHLY SPECIFIC (≈85%), POOR SENSITIVITY (≈50%)</span>'''
*** '''Sensitivity varies by tumour grade'''
**** '''HG tumours: 84%'''
**** '''LG tumours: 16%'''
*** '''Test characteristics of urinary cytology are improved with higher stage and HG disease[https://www.ncbi.nlm.nih.gov/pubmed/25037483]'''
*** '''<span style="color:#ff0000">Due to high specificity, a positive reading regardless of cystoscopic or radiographic findings suggests the existence of malignancy in the vast majority of patients.</span>'''
**** In a study of patients with a negative workup (cystoscopy and upper tract imaging) with a persistently positive cytology, ≈40% were found to have genitourinary cancer within 24 months
*'''Atypical cytology'''
** '''15% have cancer'''
* '''<span style="color:#ff0000">Causes of false-positive/atypical urine cytology'''
*# '''<span style="color:#ff0000">UTI'''
*# '''<span style="color:#ff0000">Inflammation'''
*# '''<span style="color:#ff0000">Foreign body'''
*# '''<span style="color:#ff0000">Previous BCG'''
*# '''<span style="color:#ff0000">Radiation[https://pubmed.ncbi.nlm.nih.gov/38661067/]'''
*# '''<span style="color:#ff0000">Chemotherapy'''
*# '''<span style="color:#ff0000">Contrast'''
*# '''<span style="color:#ff0000">Instrumentation'''
* '''Indications'''
**'''Evaluation of gross hematuria'''
***'''NOT indicated in evaluation of microscopic hematuria'''
**'''Initial diagnosis of NMIBC ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418246/ 2021 CUA NMIBC Guidelines])'''
**'''Initial diagnosis of upper tract urothelial carcinoma ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418246/ 2021 CUA NMIBC Guidelines])'''
**'''Surveillance of''' 
***'''Intermediate- and high-risk NMIBC[https://pubmed.ncbi.nlm.nih.gov/27317986/ §]'''
***'''Urethra after cystectomy[https://pubmed.ncbi.nlm.nih.gov/28456635/ §]'''
***'''Urinary tract after bladder preserving therapy for MIBC[https://pubmed.ncbi.nlm.nih.gov/28456635/ §]'''
***'''Urinary tract after treatment for upper tract urothelial carcinoma[https://pubmed.ncbi.nlm.nih.gov/37096584/ §]'''

=== Other urinary markers for bladder cancer ===
* A number of tumor markers (BTA stat, BTA TRAK, ImmunoCyt, NMP22 BladderChek, UroVysion, Lewis X, CK 20, CYFRA 21.1) have shown the ability to improve the sensitivity of cytology, but specificity is lower for most
* '''NMP-22'''
** Shed into the urine
** Has a 20x higher concentration in the urine of bladder cancer patients than in non-cancer controls.
** With a cutoff of 10 units/mL, the overall sensitivity and specificity for detecting urothelial cancer were 49% and 87%, respectively