Answer
A host of newer tumor markers and molecular diagnostic indicators has been used, as follows:
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DNA ploidy and image analysis
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Chromosomal aneuploidy or polysomy
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Bladder tumor–associated antigen/analytes
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Nuclear matrix proteins [7]
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Monoclonal antibodies (ImmunoCyt)
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Hyaluronic acid and hyaluronidase
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Fibrin/fibrinogen degradation product
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Telomerase [8]
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Microsatellite instability
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Phenotypic antigens, including Lewis X, M344, DD23, and T138Ag
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Growth factors and receptors, including epidermal growth factor receptor, autocrine motility factor, basic fibroblast growth factor
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Oncogene and tumor suppressor genes
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Survivin antibody
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Molecular cytology (fluorescence in situ hybridization [FISH])
A recent review reported the following sensitivities and specificities for commonly available tumor markers [4] :
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BTAstat - sensitivity 57-83%, specificity 46-73%
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Nuclear matrix proteins - sensitivity 47-100%, specificity 60-70%
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ImmunoCyt - sensitivity 86%, specificity 79%
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Accu-Dx - sensitivity 52-81%, specificity 75-90%
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The classic appearance of carcinoma in situ as a flat, velvety patch. However, using special staining techniques such as 5-aminolevulinic acid, it has been shown that significant areas of carcinoma in situ are easily overlooked by conventional cystoscopy. Courtesy of Abbott and Vysis Inc.
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Papillary bladder tumors such as this one are typically of low stage and grade (Ta-G1). Courtesy of Abbott and Vysis Inc.
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Sessile lesions as shown usually invade muscle, although occasionally a tumor is detected at the T1-G3 stage prior to muscle invasion. Courtesy of Abbott and Vysis Inc.
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Flexible cystoscopes such as this one facilitate endoscopic tumor surveillance with minimal morbidity and excellent visualization of the urothelium. Courtesy of Olympus America Inc.
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The latest development in surveillance involves advances that integrate video chip technology on to the end of flexible cystoscopes. Courtesy of Olympus America Inc.
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Rigid cystoscopes such as this one allow biopsy collection via in-office fulguration of small tumors. Such fulguration may be performed using electrocautery or laser. Courtesy of Olympus America Inc.
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Resection of all visible tumors is possible using modern resectoscopes. Courtesy of Olympus America Inc.
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Photograph in which fluorescence in situ hybridization centromere staining identifies aneuploidy of chromosome 3. Multiple instances of overexpression of the chromosome (note the multiple red dots, which identify centromeres of this chromosome) prove aneuploidy.
