Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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
Ciatto S. Detection of Bladder Cancer Using a Proteomic Assay. JAMA. 2005;293(20):2466–2467. doi:https://doi.org/10.1001/jama.293.20.2467-a
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