title: Comparison of seven screening methods in the diagnosis of bladder cancer.
abstract: BACKGROUND
  We compared the validity (evaluated by sensitivity and specificity), reliability (evaluated by reproducibility) and yield (evaluated by predictive value, examining complexity and cost) of individual and combined tests for bladder tumour antigen stat (BTAstat), nuclear matrix protein 22 (NMP22), hyaluronic acid (HA), survivin, CD44v6, vascular endothelial growth factor (VEGF), and voided urine cytology (VUC) in detecting bladder cancer. And at the same time we evaluated the clinical value of these seven detecting methods in the diagnosis of bladder cancer.
  
  
  METHODS
  The six markers and VUC were detected in the urine of cancer group (151 patients with bladder cancer) and two control groups (50 patients with benign urological diseases and 50 healthy controls). The sensitivity, specificity, predictive value, reproducibility, examining complexity and checking cost of each marker and combined markers were calculated.
  
  
  RESULTS
  There was a significant difference between bladder cancer group and the two control groups. The sensitivity, specificity and positive predictive value were as follows: VUC (36.4%, 100.0%, 100%), BTAstat (76.8%, 87.0%, 89.9%), NMP22 (77.5%, 81.0%, 86.0%), HA (82.8%, 83.0%, 88.0%), survivin (70.2%, 85.0%, 87.6%), CD44v6 (50.3%, 79.0%, 78.4%), and VEGF (68.2%, 93.0%, 93.6%). The highest sensitivities were 91.4% for NMP22 + BTAstat and HA + NMP22, whereas the combined marker with the lowest sensitivity (62.3%) was VUC + CD44v6. The highest specificity was 93.0% for the combined use of VUC + VEGF and HA + CD44v6 had the lowest specificity (73.0%). The most convenient examining method was the detection for BTAstat, the lowest cost was the detection for HA, and the best reproducibility were the detection for BTAstat and VUC.
  
  
  CONCLUSIONS
  All the markers have obvious clinical value in diagnosis of bladder cancer. The use of BTAstat + HA or NMP22 + BTAstat are better examining methods in terms of validity, reliability, and yield.
authors.affiliation: Institute of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an 710061, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Sun
authors.forename: Da-lin
authors.initials: DL
authors.lastname: He
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ma
authors.forename: Xing-yang
authors.initials: XY
authors.lastname: Wan
authors.forename: Guo-dong
authors.initials: GD
authors.lastname: Zhu
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Luo
authors.forename: Hui
authors.initials: H
authors.lastname: He
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis*; D005260:Female; D006023:Glycoproteins / Q000032:analysis; D006801:Humans; D018960:Hyaluronan Receptors / Q000032:analysis; D006820:Hyaluronic Acid / Q000032:analysis; D051034:Inhibitor of Apoptosis Proteins; D008297:Male; D008869:Microtubule-Associated Proteins / Q000032:analysis; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D009367:Neoplasm Staging; D009687:Nuclear Proteins / Q000032:analysis; D012680:Sensitivity and Specificity; D000077022:Survivin; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis
chemical_list: D000951:Antigens, Neoplasm; C107489:BIRC5 protein, human; D014408:Biomarkers, Tumor; C112697:CD44v6 antigen; D006023:Glycoproteins; D018960:Hyaluronan Receptors; D051034:Inhibitor of Apoptosis Proteins; D008869:Microtubule-Associated Proteins; D009363:Neoplasm Proteins; D009687:Nuclear Proteins; D000077022:Survivin; D042461:Vascular Endothelial Growth Factor A; C100379:nuclear matrix protein 22; D006820:Hyaluronic Acid