How accurate is the NMP-22 assay for the diagnosis of bladder cancer?

Updated: Nov 01, 2018
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Grossman et al reported that when combined with cystoscopy, the NMP-22 test improves the detection of recurrence in patients with a history of bladder cancer. [18] Initial cystoscopy alone detected 91% of the cancers. The combination of the NMP-22 test with cystoscopy increased overall sensitivity to 99%. The NMP-22 test was significantly more sensitive than cytologic analysis of voided urine.

Of concern with the NMP-22 assay is its variability of performance in detecting bladder cancer. A multicenter study by Shariat et al assessed the variability in the diagnostic performance of NMP-22 for detecting recurrence and progression in patients with previous Ta, T1, and/or CIS and found that the manufacturer cutoff of 10 U/mL detected 57% of cases with a 19% false-positive rate. [19] For each NMP-22 cutoff assessed, NMP-22 had a higher sensitivity for detecting grade III and stage T2 or greater bladder cancer than for detecting any cancer.

No optimal cutoffs for detecting any or aggressive bladder cancer could be derived based on NMP-22 values. The authors concluded that there is a substantial degree of heterogeneity in the diagnostic performance of NMP-22 applied to populations from different institutions. There was no clearly defined NMP-22 cutoff, but there was a continuum of risk for recurrence and progression.


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