PMID- 27296150
OWN - NLM
STAT- MEDLINE
DCOM- 20170127
LR  - 20220331
IS  - 1471-2490 (Electronic)
IS  - 1471-2490 (Linking)
VI  - 16
IP  - 1
DP  - 2016 Jun 13
TI  - The diagnostic accuracy of urine-based tests for bladder cancer varies greatly by 
      patient.
PG  - 30
LID - 10.1186/s12894-016-0147-5 [doi]
LID - 30
AB  - BACKGROUND: Spectrum effects refer to the phenomenon that test performance varies 
      across subgroups of a population. When spectrum effects occur during diagnostic 
      testing for cancer, difficult patient misdiagnoses can occur. Our objective was 
      to evaluate the effect of test indication, age, gender, race, and smoking status 
      on the performance characteristics of two commonly used diagnostic tests for 
      bladder cancer, urine cytology and fluorescence in situ hybridization (FISH). 
      METHODS: We assessed all subjects who underwent cystoscopy, cytology, and FISH at 
      our institution from 2003 to 2012. The standard diagnostic test performance 
      metrics were calculated using marginal models to account for clustered/repeated 
      measures within subjects. We calculated test performance for the overall cohort 
      by test indication as well as by key patient variables: age, gender, race, and 
      smoking status. RESULTS: A total of 4023 cystoscopy-cytology pairs and 1696 
      FISH-cystoscopy pairs were included in the analysis. In both FISH and cytology, 
      increasing age, male gender, and history of smoking were associated with 
      increased sensitivity and decreased specificity. FISH performance was most 
      impacted by age, with an increase in sensitivity from 17 % at age 40 to 49 % at 
      age 80. The same was true of cytology, with an increase in sensitivity from 50 % 
      at age 40 to 67 % at age 80. Sensitivity of FISH was higher for a previous 
      diagnosis of bladder cancer (46 %) than for hematuria (26 %). Test indication had 
      no impact on the performance of cytology and race had no significant impact on 
      the performance of either test. CONCLUSIONS: The diagnostic performance of urine 
      cytology and FISH vary significantly according to the patient demographic in 
      which they were tested. Hence, the reporting of spectrum effects in diagnostic 
      tests should become part of standard practice. Patient-related factors must 
      contextualize the clinicians' interpretation of test results and their 
      decision-making.
FAU - Gopalakrishna, Ajay
AU  - Gopalakrishna A
AD  - Division of Urology, Duke University Medical Center, Durham, NC, 27710, USA.
FAU - Longo, Thomas A
AU  - Longo TA
AD  - Division of Urology, Duke University Medical Center, Durham, NC, 27710, USA.
FAU - Fantony, Joseph J
AU  - Fantony JJ
AD  - Division of Urology, Duke University Medical Center, Durham, NC, 27710, USA.
FAU - Owusu, Richmond
AU  - Owusu R
AD  - Department of Urology, University of California San Diego, San Diego, CA, USA.
FAU - Foo, Wen-Chi
AU  - Foo WC
AD  - Department of Pathology, Duke University Medical Center, Durham, NC, USA.
FAU - Dash, Rajesh
AU  - Dash R
AD  - Department of Pathology, Duke University Medical Center, Durham, NC, USA.
FAU - Inman, Brant A
AU  - Inman BA
AD  - Division of Urology, Duke University Medical Center, Durham, NC, 27710, USA. 
      brant.inman@duke.edu.
LA  - eng
GR  - TL1 TR001116/TR/NCATS NIH HHS/United States
PT  - Journal Article
DEP - 20160613
PL  - England
TA  - BMC Urol
JT  - BMC urology
JID - 100968571
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Cystoscopy/trends
MH  - Female
MH  - Hematuria/diagnosis/urine
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Urinalysis/*standards
MH  - Urinary Bladder Neoplasms/*diagnosis/surgery/*urine
PMC - PMC4906712
OTO - NOTNLM
OT  - Bladder cancer
OT  - Cytology
OT  - FISH
OT  - Sensitivity
OT  - Specificity
OT  - Spectrum effects
EDAT- 2016/06/15 06:00
MHDA- 2017/01/28 06:00
PMCR- 2016/06/13
CRDT- 2016/06/15 06:00
PHST- 2015/12/07 00:00 [received]
PHST- 2016/06/03 00:00 [accepted]
PHST- 2016/06/15 06:00 [entrez]
PHST- 2016/06/15 06:00 [pubmed]
PHST- 2017/01/28 06:00 [medline]
PHST- 2016/06/13 00:00 [pmc-release]
AID - 10.1186/s12894-016-0147-5 [pii]
AID - 147 [pii]
AID - 10.1186/s12894-016-0147-5 [doi]
PST - epublish
SO  - BMC Urol. 2016 Jun 13;16(1):30. doi: 10.1186/s12894-016-0147-5.