title: Combining cytology, TRAP assay, and FISH analysis for the detection of bladder cancer in symptomatic patients.
abstract: BACKGROUND
  There is a need to improve the performance of urine cytology in bladder cancer diagnosis. We assessed the diagnostic performance of (i) telomerase activity detected by telomeric repeat amplification protocol (TRAP) assay, (ii) cytology and TRAP assay in parallel, (iii) cytology in parallel with the in-series combination of TRAP assay and FISH analysis, and (iv) the in-series combination of TRAP assay and FISH analysis.
  
  
  METHODS
  Cross-sectional study of 289 consecutive patients who presented with urinary symptoms at a north Italian hospital between 2007 and 2008. All underwent cystoscopy and cytology evaluation, and conclusive results were available for TRAP assay and FISH analysis.
  
  
  RESULTS
  Sensitivity and specificity were 0.39 and 0.83, respectively, for cytology; 0.66 and 0.72 for TRAP; 0.78 and 0.60 for the combination of cytology and TRAP; 0.78 and 0.78 for the combination of cytology, TRAP, and FISH; and 0.65 and 0.93 for the combination of TRAP and FISH. All differences versus cytology alone were significant (P ≤ 0.011).
  
  
  CONCLUSIONS
  Compared with cytology alone, the combination of cytology, TRAP, and FISH provided the best trade-off between increase in sensitivity and loss in specificity, especially among non-bleeding patients, low-grade cancers, and early-stage cancers.
authors.affiliation: Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy. s.bravaccini@irst.emr.it
authors.forename: S
authors.initials: S
authors.lastname: Bravaccini
authors.forename: V
authors.initials: V
authors.lastname: Casadio
authors.forename: R
authors.initials: R
authors.lastname: Gunelli
authors.forename: L
authors.initials: L
authors.lastname: Bucchi
authors.forename: W
authors.initials: W
authors.lastname: Zoli
authors.forename: D
authors.initials: D
authors.lastname: Amadori
authors.forename: R
authors.initials: R
authors.lastname: Silvestrini
authors.forename: D
authors.initials: D
authors.lastname: Calistri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003558:Cystoscopy; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques; D012680:Sensitivity and Specificity; D019098:Telomerase / Q000378:metabolism; D016615:Telomere / Q000235:genetics; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000652:urine*
chemical_list: D019098:Telomerase