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CC BY 4.0 · Brazilian Journal of Oncology 2025; 21: s00441791752
DOI: 10.1055/s-0044-1791752
Original Article
Clinical Oncology

5-ALA-Induced Fluorescent Urine Cytology in Comparison with Conventional Cytology, BTA-TRAK, and NMP-22 Tests in the Diagnosis of Bladder Cancer

Rajendra B Nerli 
1   Department of Urology and Urologic Oncology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, Karnataka, India
,
Shadab Rangrez
1   Department of Urology and Urologic Oncology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, Karnataka, India
,
Shridhar C. Ghagane 
2   Dr. Prabhakar Kore Basic Science Research Centre, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, Karnataka, India
,
Parth Lalakia
3   College of Population Health, Office of Global Affairs, Thomas Jefferson University, Philadelphia, United States
,
Shoubhik Chandra
1   Department of Urology and Urologic Oncology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, Karnataka, India
,
Shreya Chandra
4   Department of Pathology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, Karnataka, India
› Institutsangaben Funding The authors declare that they did not receive financial support from agencies in the public, private or non-profit sectors to conduct the present study.
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Abstract

Introduction To assess the sensitivity fluorescent urine cytology induced by 5-aminolevulinic acid (5-ALA) in the diagnosis of bladder cancer and to compare the sensitivity and specificity with currently available markers approved by the United States Food and Drug Administration (FDA), bladder tumour antigen (BTA-TRAK, Bard Diagnostic Sciences, Redmond, WA, United States) assay based on enzyme-linked immunosorbent assay (ELISA), nuclear matrix protein 22 (NMP-22), and conventional cytology.

Materials and Methods Age- and gender-matched patients ≥ 18 years of age admitted with imaging-confirmed bladder cancer and non-malignant conditions formed the cases and controls respectively. A freshly-collected voided urine sample was divided into four parts, with each part used to perform: a) conventional cytology with Papanicolaou staining; b) the BTA-TRAK assay; c) the NMP-22 assay; and d) 5-ALA-induced fluorescent urine cytology. The resected bladder specimen was sent for histopathological examination.

Results In low-grade bladder cancers, the sensitivity of 5-ALA fluorescent cytology was of 88.02%, which was significantly higher than conventional cytology (p < 0.0001), the NMP-22 assay (p < 0.0035), and the BTA-TRAK assay (p < 0.0007). The sensitivity of 5-ALA fluorescent cytology was significantly higher in high-grade lesions when compared to conventional cytology (p < 0.0005) and the BTA-TRAK assay (p < 0.039).

Conclusions Fluorescent urine cytology induced by 5-aminolevulinic acid is a highly-sensitive test in the diagnosis of bladder cancer, and its sensitivity rates are significantly superior to those of conventional cytology, the NMP-22 assay, and the BTA-TRAK assay.

Keywords

bladder cancer - cytology - urothelial carcinoma - 5-aminolevulinic acid - sensitivity - specificity

Authors' Contribution

RBN: conception and design, final approval of the manuscript, manuscript writing, and provision of study materials or patients; SR: collection and assembly of data, data analysis and interpretation, and final approval of the manuscript; SCG: conception and design, data analysis and interpretation, final approval of the manuscript, manuscript writing, and provision of study materials or patients; PL: data analysis and interpretation and final approval of the manuscript; SC: collection and assembly of data, data analysis and interpretation, and final approval of the manuscript; SC: collection and assembly of data, data analysis and interpretation, final approval of the manuscript, and manuscript writing.


Clinical Trials

None.




Publikationsverlauf

Eingereicht: 20. Dezember 2023

Angenommen: 23. Juli 2024

Artikel online veröffentlicht:
09. Januar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Rajendra B Nerli, Shadab Rangrez, Shridhar C. Ghagane, Parth Lalakia, Shoubhik Chandra, Shreya Chandra. 5-ALA-Induced Fluorescent Urine Cytology in Comparison with Conventional Cytology, BTA-TRAK, and NMP-22 Tests in the Diagnosis of Bladder Cancer. Brazilian Journal of Oncology 2025; 21: s00441791752.
DOI: 10.1055/s-0044-1791752
 

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