Published in Cancer Detection and Prevention 2000; 24(Supplement 1).

Combination of DD23 and cytopathology in the detection of recurrent transitional cell carcinoma (TCC)

SM Gilbert MD 1, A Shabsigh MD 1, A Sawczuk RN 1, U Vasa MD 2, A Ng PhD 2, C Pickens MS 2, K Norris BS 2, S Bright BS 2, GJ O'Dowd MD 2, RW Veltri PhD 2, MC Benson MD 1, CA Olsson MD 1, IS Sawczuk MD 1

1 Columbia University, College of Physicians and Surgeons, New York, NY, 2 UroCor, Inc, Oklahoma City, OK, USA,

AIM: Murine monoclonal antibody DD23 recognizes an 185kd tumor-associated antigen expressed in human bladder cancer cells. This study determined if DD23 increases the sensitivity of urinary detection of TCC when combined with cytopathology. METHODS: Using alcohol-fixed urinary cytology, matched voided urine and bladder wash specimens were evaluated for DD23 expression. 81 patients with a history of bladder cancer had urine cytology analysis performed in a single reference laboratory. Using an indirect chromogen-based avidin-biotin cellular immunoassay, specimens were evaluated for presence of DD23 antigen. DD23 expression was stratified into the following urinary cytology categories: TCC, dysplasia, atypia, and no evidence of disease. Cytology diagnoses of TCC and dysplasia were considered positive independent variable results for statistical analysis. RESULTS: The 81 patients produced 151 urine specimens for which both biopsy and cytology information were obtained. Of these, 64 cases were biopsy confirmed TCC. These recurrences were used as the dependent variable to assess the accuracy of cytology testing. For the detection of TCC/dysplasia, DD23 antigen univariately had a sensitivity of 70.3% and specificity of 59.8%. Combined with cytopathology, DD23 enhanced the sensitivity of TCC/dysplasia detection from 43.8% (cytology alone) to 78.1%. For low-grade TCC, DD23 enhanced sensitivity from 20.0% (cytology alone) to 55.0%. For high-grade TCC, DD23 enhanced sensitivity from 64.0% (cytology alone) to 76.0%. Combined sensitivity of DD23 and cytology in bladder wash specimens was 87.5%. CONCLUSION: DD23 antigen expression used as an adjunct to cytopathology enhances the sensitivity of urinary cytology detection of TCC.

KEY WORDS: cytology, transitional cell carcinoma.

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Paper presented at the International Symposium on Impact of Biotechnology on Cancer Diagnostic & Prognostic Indicators; Geneva, Switzerland; October 28 - 31, 2000; in the section on prognostic markers.