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May 25, 2005

Detection of Bladder Cancer Using a Proteomic Assay

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(20):2466-2467. doi:10.1001/jama.293.20.2467-a

To the Editor: In their study of the accuracy of the NMP22 proteomic assay for detecting bladder cancer,1 Dr Grossman and colleagues provide no description of ultrasonography results in their patients. Although studied mostly in symptomatic patients, ultrasononography has been found to have a sensitivity of 80% to 90%, which is higher than cytology2,3 or the 56% sensitivity for the NMP22 assay reported in this study. When comparing a new assay to standard assessment of high-risk and/or symptomatic subjects, ultrasonography should therefore be one of the compared strategies. Given the low prevalence of cystoscopy-detected cancer in this population (79/1331 [5.9%]), the routine use of cystoscopy might be regarded as too aggressive. It would be interesting to know what the positive predictive value would be for patients who are ultrasonography/cytology positive or negative and what would be the incremental cancer detection rate attributable to the NMP22 assay beyond what would already be found with ultransonography and cytology.